Type of Surgery

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

How it works

Restricts intake only

Restricts  food intake and has some malabsorption of nutrients

Restricts food intake but greatest action of surgery is in malabsorption element.

What it does

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

How it's done

stomach is stapled so that it's in two parts, an upper pouch and the rest. A hole in the stomach separates the two parts and a hard silastic ring is placed around the opening of the pouch into the main stomach

Stomach is stapled and divided into two parts, the 1 or 2 oz "pouch" and the larger part which is bypassed.  The top part of the small gut is also bypassed (18 inches to 6 feet).  The top part of the gut - bypassed - is where you digest vitamins and absorb a lot of food.

Stomach is stapled lengthwise so it remains normally functional but only 10 percent of the original size (the rest is removed from the body).  Small gut is rearranged so about 60 percent of it is bypassed, leaving about 2.5 feet of small gut where food goes which is usually called "the common tract"  In this surgery, the gall bladder and appendix are removed at the time of original surgery.

Long term weight loss success

Poor

This surgery has a very high re-gain rate.

Average

70% maintain some weight loss, 25 percent gain it all back (see Hebrew University Study, 1999)

Above Average

Among those few long termers who have been identified, some regain has occurred in some (20-50 lbs), a few have regained to morbid obesity and most have kept off some weight

American results show a high re-gain rate.  This seems to differ from European results probably due to greater activity level in Europe.  Miller study (900 patients ) showed the end weight loss similar to the gastric bypass

factor

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

Complications - short term 

vomiting, heartburn, blocking of opening to larger stomach

 vomiting and nausea, plugging of the openings from the pouch to the small gut, poor absorption of fat soluble vitamins, E, K, A, and D, narrowing of the openings from the pouch to the small gut and where the bypassed small gut is reconnected, bowel obstruction, hernia (even with lap surgery), intestinal and pouch ulcers and or rotting, dumping syndrome (bad reaction to carbs intake), protein deficiency, ketosis (body consumes itself for proteins etc), staples coming out causing leakage of digestive juices and possible peritonitis (peritonitis can cause multiple disabilities), heart damage from rapid weight loss and/or from surgical complications, damage to organs surrounding surgical field (especially in lap procedures)..

Same as gastric bypass except, most do not have dumping syndrome, less ulceration of small gut, no narrowing of stomach opening (bottom stomach valve still in place), less vomiting.

In addition to complications seen with gastric bypass, the following can occur:

severe protein starvation (see Scopinaro report), very foul smelling diarrhea, anemia

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

long term complications - may happen but does not always happen

autoimmune disease can occur if patients don't take liquid supplements - apparently patients tend to stay away from nutritious foods due to difficulty in eating them, teeth rotting from vomiting (most longer term patients have this), adhesions blocking opening to pouch requiring surgery. Adhesions covering stomach where stapled

osteoporosis, general malnutrition, anemia, bowel obstruction, blind loop, kidney stones, narrowing of the stomas, ulceration in the pouch and small gut, organ failure, weight re-gain.

Taking Vitamin B12 shots will cause the patient to avoid bad side effects from a B12 deficiency.

osteoporosis, general malnutrition, anemia, bowel obstruction, blind loop, kidney stones, narrowing of the stomas, ulceration in the pouch and small gut, organ failure, weight re-gain

Additionally see list of complications for JIB at www.asbs.org BPD is variation of the JIB

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

is it reversible?

Not really. If patient seeks reversal in the first couple of years after surgery, they can remove the silastic ring which gives the patient some relief from the narrowing of the opening.

Basically not reversible. They can reconnect the larger stomach (and bypassed intestine) to the pouch. Patient still has some issues like adhesions and some vomiting but at least is digesting all vitamins

The DS/BPD is easily reversible with the exception that if the 10 percent of stomach which is left becomes ulcerated, then the person ends up without a stomach. This appears to only happen in a small percentage of cases.

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

Long term dietary modification

Extremely poor diet- Patients have difficulty consuming nutritious food since it plugs the opening at the silastic ring.

After a year or two, most patients can eat most foods even sweets but have to restrict intake and exercise because they tend to regain easily. Many of them join Weight Watchers or Jenny Craig

This surgery "works" the longest of all but at about the 7 year point or so, patient must start restricting food intake and exercise or regains. Fatty food tends to cause more diarrhea.

Nutritional Supplement

Multi vitamin, Iron, Calcium For life, possibly B12 shots

Protein drinks (protein poorly digested), B12 shots once or twice a week (NECESSARY), sub lingual iron, calcium citrate (not known how much calcium patients can absorb - too much calcium not used ends up in the kidneys as stones)

Protein drinks, calcium citrate (see gastric bypass note on absorption), Possibly B12 shots, sub lingual iron - SHOULD BE CLOSELY MONITORED by gastroenterologist for LIFETIME

VBG, vertical banded gastroplasty

RNY, Gastric Bypass, Roux-en-Y, LAP, RNY

Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS

DS (stomach part) since early 1990's