| | Restriction and Malabsorption | Restriction
(Stomach only) |
| Roux en Y Gastric Bypass | Sleeve Gastrectomy | Adjustable Gastric Band |
Anatomy | Small gastric pouch (30ml) connected to the small intestine and bypassing 1m of intestine | Long narrow gastric pouch (150ml) | 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
| |
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
- 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. |