Compare Surgical Procedures
Type of Operation |
RNY, Gastric Bypass,Roux-en-Y,
LAP, RNY |
Duodenal Switch, BPD-DS,Distal
Gastric Bypass with DS |
VBG |
Lap Band |
| Modality of Weight Loss | Restrictive 1-3 ounce stomach | Restrictive and Malabsorptive | Restrictive | Restrictive 1-3 ounce stomach (15cc)
|
| Description | A very small pouch of fundus connected to a limb of small bowel. Pyloric Valve bypassed. | Sleeve gastrectomy, with ~8ounce pouch. Pyloric valve functional. The bilio-pancreatic secretions are kept separated from food to limit absorption except the last ~75cm of small bowel.
|
A silastic ring is used to create a small pouch of stomach. | An adjustable silicone constricting band is place completely around the very top part of the stomach creating a very small pouch. |
| Long term success | Average. 60-70% Peak results 18-24 months [8],[9],[10],[11]>30% regained >15% or lost <50% [12] | Above Average. 70-80% excess weight loss reported over long term follow up.[3],[4],[5],[6],[7] | Poor. Only 26% of patients maintain >50%
of excess weight
|
No long term studies yet available. At best should be similar to VBG. |
| Complications Non Surgical |
68.8% “continued” problem with vomiting, 42.7% plugging of the gastric pouch outlet.[13] 12% stenosis & 12% ulceration, with over all stomac complication in 20%.[14] Up to 76% of Patients develop Dumping Syndrome, with no association between severity of Dumping Syndrome and weight loss.[15] | Fat soluble vitamin deficiency- Rarely seen with adequate dietary supplements, in addition to a normal healthy diet. Protein malabsorption- again with healthy well balanced diet far less common than seen in VBG or RNY patients with stenosis or who only consume high sugar/calorie drinks.
|
21% Vomit more that once a week.
14% have heartburn.[1] Binging and purging very common secondary to pain. |
89% of patients have at least one
side effect. Nausea and Vomiting 51% Heart Burn 34% Need for re-operation or removal as high as 25% [17] |
| Opinion | “Gold standard” with frequent complications and hospital visits for patients 8. | Technically a difficult operation to perform. Division of the post pyloric duodenum is a difficult step and could be dangerous in an inexperienced hand. | Poor long term results with VBG[2] | Actually not a new idea and was abandoned years ago. Some top surgeons in the field feel its resurgence will give bariatric surgery a bad reputation [18]
|
| Summary | A restrictive procedure rendering a patient to a very limited diet, with significant complications. Long term results acceptable. | The best surgical solution available for treatment of Morbid obesity. Allows a patient to lead a normal life with normal dietary intake of meals in smaller volume, without the side effect of dumping syndrome, continued vomiting, plugging, etc.
|
A restrictive operation with poor long term track record and numerous complications. | Restrictive procedure with no long term studies. Preliminary results disappointing.[19] |
| Long Term Dietary Modification | Significant dietary restriction. The unhealthiest diet after any weight loss surgery. Meat intolerance in majority of Pt.[16]Patients resort to high calorie drinks because can not tolerate “regular” meals
|
Most balanced diets tolerated well with no adverse effects. Patients tolerate “normal” diet. | Extremely poor diet- Patients are
not able to consume any solids since it plugs the opening at the silastic
ring.
|
The same as VBG |
| Nutritional Supplement Individual patients requirements may differ. May also differ among physicians. |
Multivitamin, Iron, B12, Calcium for life | Multivitamin and Calcium for life. | Multi vitamin, Iron, Calcium For life | The same as VBG |
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