Types of Bariatric Surgery - 16 Established & Experimental Procedures

The types of bariatric surgery you should consider depend on a number of factors, including how much weight you want to lose, which health problems you are looking to improve, each surgery’s risk level and how much they cost. There is no “one size fits all” procedure, so we’ll help you determine which ones best fit your goals.

Categories of bariatric surgery

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All types of bariatric surgery work in one of 3 ways (an overview of each surgery is provided further down the page)…

  1. Restrictive surgeries shrink the size of the stomach which reduces the amount of food it can hold. This makes you feel full when eating much sooner than you did before surgery. Primarily restrictive procedures include…
    • Vertical banded gastroplasty
    • Adjustable gastric banding (lap band surgery)
    • Gastric sleeve
    • Transoral gastric volume reduction
  2. Malabsorptive surgeries rearrange and/or remove part your digestive system which then limits the amount of calories and nutrients that your body can absorb. Treatmens with a large malabsorbtive component result in the most weight loss but tend to have higher complication rates.

    There are no longer any purely malabsorptive operations being performed (the jejunal ileal bypass was a purely malabsorptive procedure but it is no longer performed).
  3. Combination – When surgery combines both restrictive and malabsorptive techniques, it is know as a “combination” procedure. Most types of bariatric surgery carry at least a small element of both components, but the following surgeries achieve a notable portion of weight loss from each…
    • Gastric bypass (more malabsorption than the restrictive procedures listed above, but works primarily through restriction)
    • Mini-gastric bypass (also works mainly through restriction)
    • Duodenal switch (more malabsorption - the sleeve stomach is the restrictive portion and the inestinal bypass (duodenal switch) is the malabsorptive component)
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Open vs Laparoscopic Types of Bariatric Surgery

Most bariatric procedures can be performed either open or laparoscopically. Open surgery may be required in rare cases (such as a build up of scar tissue from previous operations), although with a good surgeon laparoscopic surgery is usually a much better option. It results in shorter hospital stays, lower infection rates and smaller scars.

"Laparoscopic weight loss surgery results in shorter hospital stays, lower infection rates and smaller scars."

Open surgeries are performed by making a relatively large incision in the abdomen and carrying out the operation by direct observation through the open incision. 

While many surgeons still perform open bariatric surgery successfully, these surgeries have a longer recovery time and a bigger risk of infection. Obese patients’ bodies often have more difficulty healing which can complicate things further.

With open bariatric surgery, you should expect to be in the hospital for up to 5 days or more.

With laparoscopic weight loss surgery, the surgeon makes five or six small incisions that are just big enough to pass surgical instruments through. Smaller incisions mean less healing time, so you could leave the hospital in as soon as 2 days or less.

In addition to other medical instruments, the incisions are used to insert a special camera. The surgical camera projects the inside of the patient’s body onto a screen, and the surgeon uses that image to perform the surgery.

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Stomach Banding vs Stomach Stapling

Many patients now think about surgery in terms of "banding" versus "stapling".

Stomach banding, also called gastric banding or lap band surgery, is the process of placing a synthetic band around the upper portion of the stomach. It works by creating a small "pouch" at the top of the stomach just below the esophagus, thus dramatically reducing the amount of food a patient can eat.

The primary procedure that utilzes stomach banding is gastric banding surgery, more commonly known as lap band surgery (vertical banded gastroplasty (VBG) surgery also utilizes a band, but it is only performed in special circumstances and also involves stapling).

Stomach stapling, on the other hand, is used to either section off or seal the part of the stomach that remains after the other portion is removed (VBG works differently here as well - more on how in the next section). Procedures that utilize stapling include:

  • Roux-en-Y gastric bypass
  • Duodenal switch
  • Gastric sleeve surgery
  • Mini gastric bypass surgery

Generally speaking, banding procedures - more specifically, lap band surgery - result in less weight loss but have fewer serious complications. Gastric banding is also reversible, meaning that the band can be completely removed thus returning the digestive tract to its original state. However, gastric banding has been found to have a higher rate of minor complications than procedures involving stapling.

In contrast, stomach stapling should be considered permanent. It tends to result in greater and more consistent weight loss among patients along with a greater reduction in obesity-related health problems, but it does carry a higher risk of serious complications.

The following section will give you a high level overview about how banding and stapling are utilized in each procedure...

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Overview of the 16 Types of Bariatric Surgery (with links to more details)

Jump down to the types of bariatric surgery that interest you by clicking one of the following links or scroll down to review them all. Further down the page we will compare and review the pros and cons of each.

Established Types of Bariatric Surgery

Experimental Types of Bariatric Surgery

To review all procedures currently being investigated, see our Experimental Weight Loss Surgery Procedures page. You can also click one of the following to jump straight to your procedure of interest.

Established Types of Bariatric Surgery

Gastric Bypass Surgery (Roux-en-Y)

gastric bypass surgery

Gastric bypass, also called Roux-en-Y or RNY for short, is the most commonly performed bariatric surgery in the United States.

An entire section of our web site is dedicated to this popular and effective procedure, so we’ll save most of our discussion about it for those pages (link is below). The surgery is mainly restrictive in nature, but it also has elements of malabsorption.

From a very high level perspective, to perform gastric bypass surgery the surgeon...

  1. Cuts and staples the top portion of the stomach to create a small pouch at the end of the esophagus
  2. Leaves the remainder of the stomach attached to the top of the small intestines
  3. Goes further down the small intestine, cuts it, and attaches it to the pouch
  4. Takes the end of the small intestine that is still connected with the non-pouch portion of the stomach and attaches 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.

It’s much more easily understood by watching a video…

Most patients have successful long term weight loss with minimal weight regain. However, over time some patients' stomach pouch or stoma (the opening between the stomach and small intestines) can stretch causing signifcant weight regain.

In these cases, gastric bypass revision surgery may be appropriate.

See our Laparoscopic Gastric Bypass Surgery page for all the details specific to this surgery.

Alternatively, contact an experienced local qualified surgeon. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Adjustable Gastric Banding (Lap Band Surgery)

lap band surgery

This is the second most popular U.S. bariatric surgery procedure and is restrictive in nature. It’s been used in Europe since the 90’s, but wasn’t approved by the FDA in the States until 2001.

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.

Here’s the procedure…

There is also an entire section devoted to this procedure. See Lap Band Bariatric Surgery: Complete Reference Guide to learn more.

To review the specific differences between gastric bypass and lap band surgery, see our Lap Band vs Gastric Bypass page.

Alternatively, contact an experienced local qualified surgeon that performs both lap band and gastric bypass surgery. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Gastric Sleeve Surgery (Vertical Sleeve Gastrectomy)

gastric sleeve surgery

The Vertical Sleeve Gastrectomy (VSG) is extremely effective and safe as compared with the other procedures, and it may even work better than gastric bypass or lap band surgery in terms of weight loss. However, it is not adjustable or reversible like lap band surgery and it does not appear to be as effective as gastric bypass in resolving obesity-related health problems.

The procedure is performed by dividing 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…

Read more on our Gastric Sleeve Surgery page.

Alternatively, contact an experienced local qualified surgeon. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Biliopancreatic Diversion with Duodenal Switch (BPD/DS) (Duodenal Switch)

Duodenal Switch Surgery (DS)

More simply referred to as a Duodenal Switch, this procedure could be classified as a Gastric Bypass/Gastric Sleeve combination with a twist….

  1. A large portion of the stomach is removed to create a cylinder-shaped pouch connecting the esophagus to the top of the small intestine.
  2. The top of the small intestine is cut, but the surgeon leaves part of the duodenum, or the top part of the small intestine where most chemical digestion occurs, attached to the stomach.
  3. The surgeon then cuts the small intestine several feet down. The part that is still attached to the large intestine (or colon) is connected to the duodenum.
  4. 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.

Since the stomach is shrunk and only a small portion of the intestine has a chance to digest food before it enters the colon, the duodenal switch procedure is both restrictive and malabsorptive. But this surgery is effective mainly because of malabsorption.

See our Duodenal Switch page for all of the details.

Alternatively, contact an experienced local qualified surgeon. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Vertical Banded Gastroplasty (“Stomach Stapling” or VBG)

Insurance companies typically cover this surgery (along with gastric bypass, lap band and sometimes duodenal switch surgery) because it’s been around the longest and has shown decent results. However, most surgeons no longer perform it as other procedures have been found to be safer and more effective.

The Vertical Banded Gastroplasty works through restriction and is performed by creating a “hole” in the upper-middle part of the stomach and stapling the stomach from the hole to the top of the stomach so no food can pass through. Then the surgeon places a band around the opening between the hole and the side of the stomach…

See our Vertical Banded Gastroplasty page for additional information related to this procedure.

Alternatively, contact an experienced local qualified surgeon. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Mini gastric bypass surgery (MGBP)

mini gastric bypass surgery

As the name suggests, the mini gastric bypass is like the Roux-en-Y gastric bypass discussed above but is a simpler version of that procedure.

Since it’s less invasive, MGBP has less complications and a faster recovery associated with it. But there is debate surrounding whether the long-term results are as good as Roux-en-Y gastric bypass, and evidence has been presented suggesting that less experienced surgeons sometimes promote and perform the surgery due to its less complicated nature.

It is also more likely to lead to bile reflux gastritis, a painful and hard-to-treat condition that may increase the risk of stomach cancer.

With the Roux-en-Y gastric bypass (RNY) reviewed above, there are two surgical attachments made…

  1. The small intestine is cut and attached to the small pouch (top part of the stomach)
  2. The end of the small intestine that is still connected with the remainder of the stomach is attached it to the bottom of the “Roux limb”

During the laparoscopically performed Mini Gastric Bypass the small intestine is not cut. Rather, a tubular chamber is partitioned from the stomach at the base of the esophagus (larger than the RNY pouch) and is connected about six feet down the small intestine. Since the mini bypass bypasses much more of the intestine than a standard gastric bypass, it will likely lead to higher vitamin and mineral deficiencies.

In addition, the MGBP only uses one connection where the RNY uses two…

See our Mini Gastric Bypass Surgery page for all of the details.

Alternatively, contact an experienced local qualified surgeon. Most qualified surgeons offer free seminars and/or free one-on-one consultations that teach you about your options and their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Comparison of the Types of Bariatric Surgery

Patient Experiences

At the very bottom of this page you'll learn which procedure other visitors chose and why. Please share your thoughts and experiences as well!

As you review this page and the pages we’ll guide you to, keep the following in the back of your mind…

Bariatric surgery procedures that result in more weight loss are often accompanied by higher risk and additional lifestyle changes.

The following shows a high level comparison of all major types of bariatric surgery. Below the chart we’ll get into a summary of the positives and negatives of each procedure and how they compare to one another.

Types of Bariatric Surgery
(click links for more info)
Category (explained above) Average Long-Term
Excess Weight Lost
(approx. %)
Comp- lication Rate Research Ranking* (and reason if below ‘A’)
*We developed the Research Ranking scores using a combination of factors including supporting research for short- and long-term weight loss, complication rates, risk factors and insurance coverage.

Percentages listed for the above types of bariatric surgery are meant to provide a rough idea for each procedure. No studies are available that directly compare all types of bariatric surgery, so we have combined the results of many studies.
Gastric Bypass (Roux-en-Y) Combination (primarily restrictive) 50 to 70% Up to 15% A
Gastric sleeve surgery (Vertical Sleeve Gastrectomy) Restrictive 65% to 75% Up to 10%
A
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Mal-absorptive 65% to 75% Up to 24%
A
(Due to higher complication rate and higher average weight loss, this procedure is more commonly chosen by Super Obese/BMI 50+individuals)
Gastric Banding (i.e. Lap Band) Restrictive Extremely variable – average is about 50%, but ranges from 25% to 80% Up to 33%
B
(Long-term studies are showing a high long-term complication and re-operation rate; however, many patients still choose this procedure because it is reversible, easily adjustable and has been successful for many other patients)
Vertical Banded Gastroplasty (VBG)  Restrictive 50% to 60% Up to 21%
C
(this procedure is rarely performed anymore)
Mini gastric bypass surgery Combination (primarily restrictive) Needs more research.
Studies conducted
to date show 60% to 70% range.
Up to 8%
C
(should likely be avoided due to increased rates of bile reflux gastritis and higher likelihood of malabsorption vs Roux-en-Y gastric bypass)
Transoral gastric volume reduction (TGVR) Restrictive Needs more research n/a
C
(very promising, but still too new)
TOGA System Restrictive n/a n/a
D
(these technologies are something to look out for, but additional research is needed before we can recommend them)
EndoBarrier Endoluminal Lining Mal-absorptive n/a n/a D
(these technologies are something to look out for, but additional research is needed before we can recommend them)
Implantable Maestro System neither restrictive nor mal-absorptive; electrical impulses said to affect hunger n/a n/a D
(these technologies are something to look out for, but additional research is needed before we can recommend them)
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Summary of Positives & Negatives of All Types of Bariatric surgery
(click links below to jump to pages dedicated to each surgery)

Following is a comparison of the four procedures that have received a research ranking of ‘A’ or ‘B’. It doesn’t necessarily mean that other procedures aren’t effective. Either they just don’t have enough research available for us to confidently compare them at this time (TGVR and gastric pacing) or there is too much controversy surrounding them (mini gastric bypass).

Roux-en-Y Gastric Bypass

Patients typically don’t lose as much weight after laparoscopic gastric bypass surgery as they do after the more complicated duodenal switch, but 60 to 70% of excess weight lost after gastric bypass is substantially better than after banding procedures (lap band and VBG).

The presence of dumping syndrome is a significant difference versus other procedures. While the symptoms are extremely uncomfortable, many patients feel that they help to keep their diet and long-term weight loss on track.

In addition, the malabsorptive component of gastric bypass can lead to malnutrition issues, so careful and ongoing attention should be paid to diet supplementation. However, malnutrition risks are much less after gastric bypass than after the duodenal switch.

Adjustable Gastric Banding (Lap band surgery)

Lap band surgery has an impressively low rate of serious complications and is the only well-researched surgery that is completely reversible.

While the average 50% of excess weight lost is a decent percentage, the amount each patient could lose ranges from below 25% to over 80%. It also has a much higher rate of minor complications and reoperations than any other procedure. 

The number of doctor visits after surgery is another consideration. Patients see their surgeon up to 10 times or more in the two to three years following surgery for band adjustments.

Concerningly, longer-term research is showing an alarmingly high rate of lap band failures and required reoperations - as many as one in three patients. For these reasons, some surgeons are choosing to no longer perform lap band surgery.

However, Lap Band surgery still has many champions due to the fact that it's (a) reversible and (b) much less invasive than the other established procedures.

See our Lap Band vs Gastric Bypass page for a full comparison of the two most commonly performed bariatric procedures.

Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch, or “Duodenal Switch” for short, deserves more credit and attention than it’s been given by those seeking bariatric treatment. On average, it results in more weight loss than any other procedure.

And although it carries the highest risk of complications, it's mortality risks are on par with other procedures and it may be the best procedure for those with a body mass index of 50 or over (“super-obese”) in terms of average weight loss and elimination of obesity health problems.  (See our How to Calculate BMI page for more about body mass index.)

However, its higher rate of serious complications and the amount of malabsorption that it causes command careful consideration by the patient and surgeon before moving forward.

Gastric Sleeve (Vertical Sleeve Gastrectomy)

Gastric sleeve surgery appears to be catching up with gastric bypass in terms of popularity and adoption by surgeons; it carries the low risks of gastric banding with the higher weight loss associated with gastric bypass.

Compared with gastric bypass, it appears to carry a lower rate of complications and reoperation. But recent research shows that it may not be as effective at resolving obesity-related health problems such as resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis.4

The main concern is that the pouch could stretch over time.

Summary 

Your individual situation will determine which surgery is right for you, but following is a general summary…

Roux-en-Y Gastric bypass is a “best of all worlds” procedure. It has a relatively low complication rate compared with its high levels of excess weight loss and significant improvement in co-morbidities. Its popularity also means that there are more surgeons out there with enough procedures under their belt to improve your chances for a good outcome.

However, lap band surgery is a better option for some mentalities. It has a lower risk of serious complications, and for those who are not 100% sure that they’re ready to permanently change their body, it is completely reversible and can be easily converted into a more extreme procedure down the road.

Unfortunately, it has a very high variability in weight loss from patient to patient, and is associated with more minor and annoying complications. Lap band surgery is also much more likely to require reoperation over the long-term.

The duodenal switch is probably the most effective procedure for the super-obese. It has been proven to be successful (result in at least 50% of excess weight loss) for about 85% of patients after 3 years.2

It may also be the most effective procedure for treating obesity-related health problems. For example, in one study duodenal switch surgery cured 100% of diabetic patients (Alverdy and Prachand, University of Chicago).

The amount of weight loss long-term also appears to be better than any other procedure, but it has the highest rate of serious complications and the most intensive bariatric vitamin adherence requirements due to the level of malabsorption.

Gastric sleeve surgery is the newest addition to many bariatric surgeons' list of available surgeries. It is less complicated than gastric bypass and duodenal switch and leads to similar weight loss.

While not reversible or easily adjustible like the lap band, it carries a much higher weight loss and much lower risk of reoperation.

Gastric sleeve surgery appears to be a bit safer than gastric bypass in terms of reoperation and complications, but gastric bypass seems to have a better effect on many obesity-related health problems.

Vertical banded gastroplasty has some positives, especially for patients with certain health problems. But in general, it is no longer being performed as the other procedures have shown to be safer and more effective.

Mini gastric bypass surgery and Transoral Gastric Volume Reduction do not have enough long-term research available. (Sign up for our Bariatric Surgery Blog if you want to stay up to date on new research as it becomes available).

For United States visitors, see our Weight Loss Surgery Insurance page to learn how to determine which procedures your insurance will cover.

For Canadian visitors, see our Bariatric Surgery Canada page for insurance coverage details, expected wait times, and a list of clinics and surgeons by province.

For Australian visitors, see our Weight Loss Surgery Australia page for cost information with and without private insurance, to learn what Medicare will pay and more.

For all visitors, weight loss surgery financing programs are also available for most bariatric procedures.

Hear It Straight from the Source... For Free

Most surgeons offer free seminars that teach you about your options and their office's specific results. The seminars also allow you to get to know the surgeon prior to a one-on-one consultation (usually free as well).

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

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Which bariatric surgery procedures fit you best and why?

Deciding between bariatric surgery procedures can be difficult, and many other visitors to this site are still struggling with their decision.

Please share how you were able to decide by including any or all aspects of your decision, such as...

1. The top 2 procedures you were deciding between and what led you to choose your procedure.

2. What factors ruled out certain procedures? (i.e. health/diet/nutrition issues, potential complications, etc.)

3. How much weight do you expect to lose?

4. What health problems do you expect to improve?

5. Was cost and/or insurance coverage a factor?

Enter the name of the surgery you chose

How Other Visitors Chose Their Bariatric Surgery Procedures

Click below to see contributions from other visitors to this page...

Why I Chose Lap Band Over Gastric Bypass 
Originally, I had chosen the gastric bypass surgery. It seemed like the best option for me as I had over 100 lbs to lose. However, after meeting …

Why I Chose the Lap-Band as My Weight Loss Surgery 
I'd like to tell you why I chose the Lap Band as the right weight loss surgery for me. First, I am not 'anti' any particular Weight Loss Surgery (WLS)… …

Click here to write your own.

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References

  1. Brigham and Women's Hospital. Promising Results Reported from First Completed Transoral Gastric Volume Reduction Trial. October 2008. Available at: http://www.brighamandwomens.org/medical/ppd/2008/TGVR_trial.aspx. Accessed: October 4, 2009.
  2. Prachand VN, et al. Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI ≥50kg/m2) Compared With Gastric Bypass. Ann Surg. 2006 October; 244(4): 611–619.
  3. Fobi Mal, Lee H, Felahy B, et al. Choosing an operation for weight control and the transected banded gastric bypass. Obes Surg. 2005;15:114–121.
  4. Li, Jian-Fang MDSurgical Laparoscopy, Endoscopy & Percutaneous Techniques: February 2014 - Volume 24 - Issue 1 - p 1-11 doi: 10.1097/SLE.0000000000000041

[Last editorial review/modification of this page: 2/19/2014]

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More