There are 7 types of weight loss surgery available, including:
There is no “one size fits all” procedure, so this page will help you determine which ones best fit your goals.
Weight Loss
Ranges from Part to Most of Your Excess Weight
Weight Loss: Ranges from Part to Most of Your Excess Weight
Most Weight Loss
Winner: Duodenal Switch
Runners Up: (Tie) Gastric Sleeve & Gastric Bypass
Patients lose weight quickly after most procedures, with the low point coming 12 to 18 months after the procedure.
The duodenal switch (DS), gastric sleeve, and gastric bypass are very close in terms of their average low point, but the DS pulls ahead over the long-term as it results in less weight regain over time.
Health Benefits
Diabetes, Cardiac, Asthma, Joints, Many Others
Health Benefits Diabetes, Cardiac, Asthma, Joints, Many Others
Best Health Improvement
Winner: Duodenal Switch
Runners Up: (Tie) Gastric Sleeve & Gastric Bypass
The duodenal switch (DS) seems to deserve more attention than it has gotten as it is the clear front-runner in terms of health improvement. In fact, DS surgery is even being performed on non-morbidly obese patients to treat metabolic syndrome and diabetes (1).
It works so well because it combines the restriction of gastric sleeve, making patients feel full sooner after eating, with its own brand of malabsorption to limit the number of calories that the body can absorb.
Despite its effectiveness, most surgeons tend to only consider it for super-obese patients (BMI of 50 or greater) because:
- It is more difficult to perform
- It takes longer to perform
- It requires much more diligent follow up for both surgeons and patients due to the the level of malabsorption that it causes
While not as good as the DS, gastric sleeve and gastric bypass have extremely impressive health improvement stats as well.
Procedure
7 Types Widely Performed
Procedure: 7 Types Widely Performed
Most Popular Procedure
Winner: Gastric Sleeve
Runners Up: Gastric Bypass
Procedure Fundamentals: Restriction, Malabsorption, & Vagal Nerve Stimulation
The established types of bariatric surgery work using one or more of the following techniques:
- Restrictive surgeries reduce the amount of food the stomach can hold. This makes you feel full much sooner after eating than you did before surgery. The established restrictive procedures include:
- Gastric sleeve
- Adjustable gastric banding (Lap-Band surgery)
- Intragastric balloon (gastric balloon)
- Malabsorptive surgeries rearrange and/or remove part your digestive system, which then limits the amount of calories, minerals, and/or fat soluble vitamins that your body can absorb. Treatments with a large malabsorptive component result in the most weight loss but may have higher complication rates. Malabsorptive surgeries include:
- Gastric bypass – mineral malabsorptive, not calorie malabsorptive
- Duodenal switch – mineral, calorie, and fat-soluble vitamin malabsorptive
- Vagal Nerve Blocking uses controlled electrical stimulation to block hunger signals sent from your stomach to your brain. The only FDA-approved device is:
- vBloc Therapy
- Aspiration uses gravity to empty a portion of your stomach’s contents through a system similar to a feeding tube. This prevents the food from being fully digested, leading to you losing weight. The only FDA-approve device is:
- AspireAssist
Experimental Procedures
Not included above are a few promising experimental procedures which can be reviewed on our Experimental Weight Loss Surgery page.
Rejected & Outdated Procedures
Two other procedures which are generally rejected by surgeons and/or outdated include:
Why They Work & How They’re Performed
This section reviews how each of the generally accepted procedures work and how they are performed, including videos for each. Click the procedures for more information:
Gastric Sleeve
Why Gastric Sleeve Works
- Reduced stomach size makes the patient feel full sooner after eating
- Removed portion of the stomach means fewer hunger-causing hormones are secreted, causing patient to feel less hungry generally
How Gastric Sleeve Is Performed
Gastric sleeve surgery, also called the Vertical Sleeve Gastrectomy (VSG), is performed by removing a large portion of the stomach to create a long pouch that connects the esophagus to the small intestine. The pouch is stapled and the rest of the stomach is removed. Some surgeons take an additional step to reinforce the staple line, although whether that is effective is up for debate.
Gastric Bypass
Why Gastric Bypass Works
- Reduced stomach size makes the patient feel full sooner after eating
- Rearranged intestines causes the body to absorb fewer minerals
- Dumping syndrome symptoms deter patients from eating unhealthy foods
How Gastric Bypass Is Performed
Gastric bypass, also called Roux-en-Y gastric bypass or RNY for short, is performed using the following steps:
- Cut and staple the top portion of the stomach to create a small pouch at the end of the esophagus
- Leave the remainder of the stomach attached to the top of the small intestines
- Go further down the small intestine, cut it, and attach it to the pouch
- Take the end of the small intestine that is still connected with the non-pouch portion of the stomach and attach it to the bottom of the “Roux limb.” This allows the digestive juices produced by the stomach to “meet up” with the food in the intestines.
Duodenal Switch (DS)
Why the Duodenal Switch Works
- Reduced stomach size makes the patient feel full sooner after eating
- Removed portion of the stomach means fewer hunger-causing hormones are secreted, causing patient to feel less hungry generally
- Rearranged intestines causes the body to absorb fewer calories and minerals
How the Duodenal Switch Is Performed
More formally known as the Biliopancreatic Diversion with Duodenal Switch, the DS surgeon starts with a gastric sleeve to reduce the stomach size, then rearranges the intestines to reduce the amount of calories the body can absorb.
Here are the steps:
- A large portion of the stomach is removed to create a banana-shaped pouch connecting the esophagus to the top of the small intestine (just like a gastric sleeve).
- The top of the small intestine is cut, but the surgeon leaves part of the duodenum, the top part of the small intestine where most chemical digestion occurs, attached to the stomach.
- The surgeon then cuts the small intestine several feet down. The part that is still attached to the large intestine (colon) is connected to the duodenum.
- The loose part of the small intestine (the part that wasn’t just attached to the stomach) is then attached to the small intestine so the digestive juices it creates can mix with the food coming from the stomach.
Gastric Bypass vs. Duodenal Switch: Clearing Up the Misconception
Both the DS and gastric bypass reduce the size of the stomach and rearrange the intestines. Both lead to substantial weight loss and health improvement.
So they’re kind of the same thing, right?
In fact, gastric bypass and the DS are just as different as any other two procedures. Here’s how they’re different:
- The DS stomach sleeve is much larger than the gastric bypass pouch
- The DS completely removes a large part of the stomach, whereas the gastric bypass leaves the separated part of the stomach attached to the small intestine
- Gastric bypass bypasses a much smaller portion of the small intestine, causing primarily mineral malabsorption. Calories are still largely absorbed after bypass. DS, on the other hand, bypasses a much longer portion of the small intestine, causing your body to absorb far fewer calories than after bypass. It also leads to much less absorption of minerals and fat soluble vitamins.
- Gastric bypass also bypasses the pylorus (the muscle that separates the stomach from the small intestine which is responsible for regulating how much food passes through the stomach and into the small intestine). The DS does not.
- Gastric bypass also bypasses the duodenum (the first portion of the small intestine where the digestive juices of the pancreas, liver, and gallbladder are secreted). The DS does not. Note that the duodenum is left in place after gastric bypass, but digestive juices secreted there “meet up” with the food much farther down the small intestines, greatly reducing their impact.
- The gallbladder is removed during DS surgery but is left in place after gastric bypass. The gallbladder stores digestive bile produced by the liver and releases it when you eat to help your body break down fats for absorption. Removing the gallbladder leads to even less calorie absorption for DS patients.
What do these differences mean to you?
- Gastric bypass has among the best weight loss and health improvement results among all procedures, but on average, DS is even better.
- DS has a higher risk of vitamin deficiency and requires more diligent follow up by surgeon and a stricter adherence to a vitamin regimen by the patient.
- Dumping syndrome is common for bypass patients and virtually non-existent for DS patients. Due to the much smaller stomach size and the bypassing of the pylorus and duodenum after gastric bypass, about 7 out of 10 gastric bypass patients experience dumping syndrome. Since the DS stomach sleeve is much larger and since the DS maintains the function of the pylorus and duodenum, DS patients do not experience dumping syndrome.
- DS is more complicated to perform. As a result, there are fewer experienced surgeons available to perform it. With all else being equal, whether or not DS has a higher risk of complications is unclear. Available research does show a higher DS complication rate, but:
- DS is more commonly performed on heavier patients who have an inherently higher risk of complications
- The more experienced the surgeon, the lower the risk of complications. Since the DS is much less common, surgeons often do not have as much experience performing it, leading to higher complication rates.
Lap-Band
Why Lap-Band Surgery Works
- A band wraps around and squeezes a narrow section in the upper-middle part of the stomach. This creates a smaller stomach “section” above the band which fills up quicker after eating, causing the patient to feel full sooner and eat less.
How Lap-Band Surgery Is Performed
The Lap-Band, also called the gastric band or laparoscopic adjustable gastric band, has been used in Europe since the 90’s but wasn’t approved by the FDA in the States until 2001. It has since fallen out of favor in many practices due to its high long-term failure rate.
Apollo Endosurgery, Inc., the maker of the Lap-Band, insists that long-term failures are the result of patients not adhering to the strict follow up that is more typical among other procedures. They say they are reinventing their support process to improve Lap-Band’s reputation.
The Lap-Band surgery procedure involves the sewing of a silicone and Silastic band around the top of the stomach. A balloon around the inner surface of the band (imagine the inside of a bicycle tire) is connected to a tube that leads to a half-dollar-sized port above the abdominal muscles but below the skin.
During follow up visits, your doctor will add or remove saline solution (salt water) to make it tighter or looser. The tighter it is, the less hungry you feel and vice-versa.
vBloc Therapy
Why vBloc Therapy Works
- Implanted device periodically blocks the vagal nerve and prevents it from delivering hunger signals to the brain, making you feel full between meals and full sooner after smaller meals.
How vBloc Device Implantation Is Performed
Your surgeon will implant the vBloc Therapy device below your rib cage just under the skin. She will then attach the device to your vagal nerve, just above the stomach, via two leads (wires). The whole procedure usually takes between 60 and 90 minutes.
Gastric Balloon
Why the Gastric Balloon Works
- An inflated balloon in the stomach leaves less room for food and causes patients to feel full sooner and eat less.
How the Gastric Balloon Is Inserted
The gastric balloon procedure is performed as follows:
- Surgeon numbs throat using a spray
- Patient may receive a sedative
- Plastic mouth guard is inserted in patient’s mouth for the scope to pass through
- Scope is passed through mouth and into stomach
- Scope is removed and balloon is passed into patient’s stomach
- Balloon is inflated with air or saline solution (depending on balloon type)
- Scope is passed into stomach again to confirm proper balloon positioning
Since it usually must be removed within 6 months, the balloon is only a temporary solution intended to “jump start” a long-term, medically-supervised diet and exercise program.
Recovery – In Hospital
6 Hours – 4 Days; Back to Work: 3 – 14 Days
Recovery – In Hospital: 6 Hours – 4 Days; Back to Work: 3 – 14 Days
Quickest Recovery
Winner: (Tie) vBloc Therapy, Gastric Balloon & AspireAssist
Runners Up: Lap-Band
The amount of time you’ll spend in the hospital and the recovery time depends on how “involved” your procedure is (how complicated the procedure is, whether part of the stomach is removed or digestive system rearranged, etc).
Diet Changes
Ranges from Moderate to Significant
Diet Changes: Ranges from Moderate to Significant
Best Post-Op Diet
Winner: Depends on Patient’s Goals
The “best” long-term diet after weight loss surgery means different things to different people. For example, “best” could mean:
- Most weight loss, regardless of sacrifices
- Fewest long-term diet changes, even if less weight loss
- Anywhere in between
Unfortunately, you can’t have it all, so the following sections provide an overview of what to expect after each procedure.
Downsides
Risk of Complications, Side Effects, & Weight Regain
Downsides: Risk of Complications, Side Effects, & Weight Regain
Fewest Risks & Side Effects
Winner: vBloc Therapy
Runners Up: (Tie) Gastric Balloon & Gastric Sleeve
Generally speaking, the types of bariatric surgery that result in more weight loss are often accompanied by higher risk and additional lifestyle changes.
The following chart highlights which complications are possible. Note that many complications listed below are associated with any type of surgery, bariatric or otherwise, and are relatively rare. For complications with procedure-specific research, we have included specific percentages.
