Surgery Comparison
|
Modality of Weight Loss
|
Restrictive and Malabsorptive
(stomach and intestines) |
Restrictive(stomach only)
|
||
| Type of Operation | Roux-en-Y Gastric Bypass (RNY, RGB) | Vertical Gastrectomy with Duodenal Switch(DS) | Vertical Gastrectomy (VG) | Lap-Bandฎ(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) 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 |