|
Modality
of
Weight
Loss
|
Restrictive
and
Malabsorptive
(stomach
and
intestines)
|
Restrictive
(stomach
only)
|
|
Type of
Operation |
Roux-en-Y
Gastric
Bypass
Surgery
|
Vertical
Gastrectomy
with
Duodenal
Switch |
Vertical
Sleeve
Gastrectomy |
Lap-Band
Procedure |
|
Anatomy |
Small 1
ounce
pouch
(20-30cc)
connected
to the
small
intestine.
Food and
digestive
juices are
separated
for 3-5
feet.
|
Long
vertical
pouch
measuring
about 4-5
oz
(120-150cc).
The
duodenum
(first
portion of
the small
intestine)
is
connected
to the
last 6
feet of
small
intestine.
Food and
digestive
fluids are
separated
for more
than 12
feet. |
Long
narrow
vertical
pouch
measuring
2-3 oz
(60-100cc).
Identical
to the
duodenal
switch
pouch but
smaller.
No
intestinal
bypass
performed. |
An
adjustable
silicone
ring
(band) is
placed
around the
top part
of the
stomach
creating a
small 1-2
ounce
(15-30cc)
pouch. |
|
|
|
|
|
|
|
Mechanism |
Significantly
restricts
the volume
of food
that can
be
consumed.
Mild
malabsorption
"Dumping
Syndrome"
when sugar
or fats
are eaten
|
Moderately
Restricts
the volume
of food
that can
be
consumed.
Moderate
malabsorption
of fat
causing
diarrhea
and
bloating
|
Significantly
restricts
the volume
of food
that can
be
consumed.
NO
malabsorption
NO
dumping
|
Moderately
restricts
the volume
and type
of foods
able to be
eaten.
Only
procedure
that is
adjustable
Delays
emptying
of pouch
Creates
sensation
of
fullness
|
Weight
Loss
United
States
Average
statistical
loss at 10
years |
70%
loss of
excess
weight
More
failures
(loss of
<50%
excess
weight)
than the
DS
|
80%
loss of
excess
weight
More
patients
lose too
much
weight or
develop
nutritional
problems
than the
RNY
|
60%-70%
excess
weight
loss at 2
years
Long
term
results
not
available
at this
time.
|
60%
excess
weight
loss.
Requires
the most
effort of
all
procedures
to be
successful.
|
Long
Term
Dietary
Modification
(Excessive
carbohydrate/high
calorie
intake
will
defeat all
procedures) |
Patients
must
consume
less than
800
calories
per day in
the first
12-18
months;
1000-1200
thereafter?3
small high
protein
meals per
day
Must
avoid
sugar and
fats to
prevent
"Dumping
Syndrome"
Vitamin
deficiency/protein
deficiency
usually
preventable
with
supplements
|
Must
consume
less than
1000
calories
per day in
the first
12-24
months,
1200-1500
thereafter
Consumption
of fatty
foods
causes
diarrhea
and
malodorous
gas/stool
Failure to
adhere to
vitamin
supplement
regimen
and
consumption
of high
protein
meals more
likely to
result in
deficiency
than RNY
|
Must
consume
less than
600-800
calories
per day
for the
first 24
months,
1000-1200
thereafter
No
dumping,
no
diarrhea
Weight
regain may
be more
likely
than in
other
procedures
if dietary
modifications
not
adopted
for life
|
Must
consume
less than
800
calories
per day
for 18-36
months,
1000-1200
thereafter.
Certain
foods can
get
"stuck" if
eaten
(rice,
bread,
dense
meats,
nuts,
popcorn)
causing
pain and
vomiting.
No
drinking
with meals
|
|
Nutritional
Supplements
Needed
(Lifetime) |
Multivitamin
Vitamin
B12
Calcium
Iron
(menstruating
women)
|
Multivitamin
ADEK
vitamins
Calcium
Iron
(menstruating
women)
|
Multivitamin
Calcium
|
Multivitamin
Calcium
|
|
Potential
Problems |
Dumping
syndrome
Stricture
Ulcers
Bowel
obstruction
Anemia
Vitamin/mineral
deficiencies
(Iron,
Vitamin
B12,
folate)
Leak
|
Nausea
and
vomiting
Heartburn
Severe
diarrhea
Kidney
stones
Stricture
Ulcers
(less than
RNY)
Bowel
obstruction
Nutritional/Vitamin
deficiencies
(Vitamin
A,D,E,K)?Loss
of too
much
weight
requiring
reoperation
Leak
|
Nausea
and
vomiting
Heartburn
Inadequate
weight
loss
Weight
regain
Additional
procedure
may be
needed to
obtain
adequate
weight
loss
Leak
|
Slow
weight
loss
Slippage
Erosion
Infection
Port
problems
Device
malfunction
|
|
Hospital
Stay |
2-3 days |
3-4 days |
1-2 days |
Overnight
(<1 day) |
|
Time
off Work |
2-3 weeks |
2-3 weeks |
1-2 weeks |
1 week |
|
Operating
Time |
2 hours |
3 hours |
1.5 hours |
1 hour |
|
Recommendation |
Most
effective
for
patients
with a BMI
of 35-55
kg/m2 and
those with
a
"sweet-tooth".
Virtually
all
insurance
companies
will
authorize
this
procedure. |
Best for
patients
with a BMI
of > 50
kg/m2.
Those with
BMI of <45
kg/m2 may
lose too
much
weight.
Higher
overall
incidence
of
complications
than other
procedures.
Most
insurance
companies
will NOT
authorize
this
procedure.
|
Utilized
for high
risk or
very heavy
(BMI > 60
kg/m2)
patients
as a
"first-stage"
procedure.
Very low
complication
rate due
to quicker
OR time
and no
intestinal
bypass
performed.
Insurance
companies
will
authorize
this
procedure
in select
patients. |
Best for
patients
who enjoy
participating
in an
exercise
program
and are
more
disciplined
in
following
dietary
restrictions.
Many
insurance
companies
will NOT
authorize
this
procedure.
|
