Weight Loss surgery comparison table

 

Type of Surgery

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB

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.

Restricts food intake only

What it does

causes a situation of low cal diet and  bulimia very low cal diet with poor absorption of fats and protein - about 300-700 calories a day, first year - some bulimia same as gastric bypass but less absorption of nutrients. Bulimia only through the gut i.e. diarrhea (some patients do vomit but not as much as with the RNY) low cal diet about 1000-1500 calories a day unless patient "cheats" surgery

 

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB

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.

a silicon ring is placed at the top of the stomach to create a roadblock for food passing quickly.  No stomach stapling involved and no intestinal bypass. The ring lies outside the stomach and has a soft inner bag which is filled with saline (to adjust size of opening into stomach) with a lead placed usually under the ribcage.

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

Uncertain

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

Adjustable lap
Band, AGB
Recovery time 1-2 days in hospital, 6 weeks recovery 1-5 days in hospital if no complications, several weeks recovery 1-5 days in hospital, if no complications - 3 months recovery 1-2 days hospital, 1-3 weeks recovery

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

vomiting, heartburn, blocking of opening to larger stomach, lack of weight loss (some patients can easily eat around this surgery), swelling of stomach if body tries to reject the band probably requires re-surgery

 

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB

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

slippage of band, infection on outside of stomach (requiring removal of band), breakage of lead to fill band, blockage of opening between pouch and stomach, esophagal damage and ulcers, stretching of the esophagus. Some American doctors are charging for fills - adjustments ($150 per fill)
 

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB

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.

totally reversible within the first 2-3 years. After that, may have adherred to the stomach and require removal of part of the stomach. Still is the most reversible of all procedures

 

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB

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.

Can eat a normal diet which means have to DIET and exercise or little to no weight is lost.

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

Same as normal. (digestive system is not changed in this surgery)
Have to exercise to keep/maintain weight loss? Yes Yes yes but can avoid exercise for a few years until surgery stops "working" yes

 

VBG, vertical banded gastroplasty

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

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

Adjustable lap
Band, AGB
Lifespan unknown - many patients still alive at the 20 year point unknown. Statistics have not been released (despite surgery has been done for 40 years) and death statistics are incorrect because most gastric bypass deaths are recorded as from other causes unknown. No statistics on this have been released. Normal (in Miller study of 900 patients over 9 years, no deaths were recorded in study participants - 98 percent followup)
how long has it been done since 1980 - invented by Mason to overcome nutritional problems with the gastric bypass (also his invention) since 1965 - a variation of the Billroth II invented in 1898 for saving lives of patients with upper small gut ulcers BPD: 1975 (intestinal bypass part)

DS (stomach part) since early 1990's

since 1993

 

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