Compare Between Surgeries

Modality of Weight Loss
Restrictive and Malabsorptive
(stomach and intestine)
Restrictive(stomach only)
Type of Operation Roux-en-Y Gastric Bypass (RNY, RGB) Vertical Gastrectomy with Duodenal Switch(DS) Vertical Gastrectomy (VG) Lap-Band®(LAGB)
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 juices 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)
  • Leakage
  • 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
  • Leakage
  • Nausea and vomiting
  • Heartburn
  • Inadequate weight loss
  • Weight regain
  • Additional procedure may be needed to obtain adequate weight loss
  • Leakage
  • 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
Our 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.
  • universite de montreal
  • American Society for Metabolic and Bariatric Surgery
  • mount sinai
  • Prince Mohamed bin Abdulaziz Hospital
  • International Federation for the Surgery of Obesity and Metabolic Disorders
  • King Khalid University Hospital
  • American Association of Bariatric Counselors
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • mc gill
  • Society for Surgery of the Alimentary Tract
  • surgery for obesity and related diseases
  • The International College of Surgeons (ICS)
  • juniper online journal of case studies
  • Obesity Medicine
  • journal of universal surgery
  • american journal of innovative research & applied sciences
  • asian council of science editors
  • medcrave
  • APMBSS
  • insight knowledge
  •  American College of Surgeons
  • Specialized Medical Center
  • Abdul Al Rahman Mishari Hospital