Compare the 3 Weight Loss Operations

 
Restriction and Malabsorption
Restriction
(Stomach only)
 
Roux en Y Gastric Bypass
Sleeve Gastrectomy
Adjustable Gastric Band
 Anatomy
Bypass

Small gastric pouch (30ml) connected to the small intestine and bypassing 1m of intestine

Sleeve

Long narrow gastric pouch (150ml)

Gastric

Adjustable silicone band (ring) around the top of the stomach, small gastric pouch (30ml)

Effects of Procedure
  • Significantly reduces meal sizes
  • Not Adjustable
  • Malabsorption (mild)
  • Dumping syndrome when sugar or fats are eaten
  • Significantly reduces meal sizes
  • Not Adjustable
  • No malabsorption or dumping
  • Moderately reduces meal sizes if eating pattern adapted
  • Adjustable
  • No malabsorption or dumping
Directly impacts on
  • Hunger
  • Speed of Eating
  • Volume of food that can be eaten
  • Absorption of calories and nutrition
  • Hunger
  • Speed of Eating
  • Volume of food that can be eaten
  • Hunger
  • Speed of Eating
Weight Loss (average at 10 years)
75% of excess weight 70% of excess weight 60% of excess weight • Requires the most effort
Long Term Daily Dietary Modification

ALL PROCEDURES WILL FAIL WITH EXCESSIVE HIGH CALORIE

  • Less than 1000 calories
  • Avoid sugar and fats to prevent “dumping”
  • Less than 1000 calories
  • Less than 1000 calories
  • 3 solid, textured meals, well chewed
  • No drinking with meals
Long Term Nutritional Supplements
  • Multivitamins required
  • Deficiencies infrequent
  • Multivitamins required
  • Deficiencies very rare
  • Multivitamins required
  • Deficiencies very rare
Potential Problems
Leak Dumping Syndrome Ulcers Bowel Obstruction Vitamin Deficiencies (B12, folate), anaemia Leak “Eating Squeezing”, nausea and vomiting initially Heartburn Inadequate weight loss Slow weight loss Inadequate weight loss Slippage Erosion Port problems “Blockage” Reoperation 10% (?)
Reversibility
Not reversible, partly modifiable Not reversible, highly modifiable Reversible, partly modifiable
Hospital Stay
3 to 4 days 2 to 3 days 1 day
Time off Work
1 to 2 weeks 1 to 2 weeks 1 to 2 weeks
Operating Time
120 minutes 90 minutes 30m minutes
Major Complications
5% 2% 1%
General Recommendation
Most eating patterns BMI >45 Sweet tooth’s, large meals, binge eating BMI 35 to 55 Self disciplined eating style BMI 35 to 45
Typical patient Summaries
“I need the operation with the greatest weight loss.” “I am worried I will not have the self discipline required to get a band to work” “I just need a constant reminder to help me: I can lose the weight, I just can’t keep it off”
You need to discuss this with your surgeon, family and friends to try and make the best choice for you. All figures given are a rough guide only.

 

Please Contact Melbourne Bariatrics on  03  9770  7189  for more information or to make an appointment

 

 

 

Royal Australasian College of SurgeonsAMA - Australian Medical AssociationFRACS - Fellow of the Royal Australasian College of Surgeonsmattu - Minimal Access Therapy Training Unit GuildfordIFSO - International Federation for the Surgery of Obesity and Metabolic DisordersMonash University
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