Types of Bariatric Surgery -
The 8 Bariatric Surgery Procedures
You Should Know About
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 (restrictive vs malabsorptive)
- Open vs Laparoscopic weight loss surgery
- 8 bariatric surgery procedures (overview of each & links to more details)
- Comparison of procedures & positives and negatives of each
- Summary
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)…
- 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
- Malabsorptive surgeries rearrange and/or remove part your digestive system which then limits the amount of calories and nutrients that your body can absorb. Malabsorptive treatments result in the most weight loss but tend to have higher complication rates. The most commonly practiced malabsorptive procedure is the…
- Duodenal switch
- 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)
Open vs Laparoscopic Weight Loss 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.
Overview of the
8 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.
- Gastric Bypass Surgery (Roux-en-Y)
- Adjustable Gastric Banding (Lap Band Surgery)
- Gastric Sleeve Surgery (Vertical Sleeve Gastrectomy)
- Biliopancreatic Diversion with Duodenal Switch (Duodenal Switch or BPD/DS)
- Vertical Banded Gastroplasty (“Stomach Stapling” or VBG)
- Mini Gastric Bypass Surgery (MGBP)
- Transoral Gastric Volume Reduction (TGVR)
- Gastric Pacing
Gastric Bypass Surgery (Roux-en-Y)
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...
- Cuts the stomach to create a small pouch at the end of the esophagus
- Leaves the remainder of the stomach attached to the top of the small intestines
- Goes further down the small intestine, cuts it, and attaches it to the pouch
- Takes the end of the small intestine that is still connected with the remainder 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 described in a video…
See our Laparoscopic Gastric Bypass Surgery page for all the details specific to this surgery.
Adjustable Gastric Banding (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 our Analysis and Cost of Lap Band Surgery page to learn more.
To review the specific differences between gastric bypass and lap band surgery, see our Lap Band vs Gastric Bypass page.
Gastric Sleeve Surgery (Vertical Sleeve Gastrectomy)
The Vertical Sleeve Gastrectomy (VSG) is quickly being adopted by surgeons throughout the country, but it has yet to be one of the insurance-approved types of bariatric surgery as it is still relatively new.
Several studies have shown it to be extremely effective and safe, and it may even work better than gastric bypass or lap band surgery. If you’re financing bariatric surgery on your own, you should definitely consider this procedure.
In general 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.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) (Duodenal Switch)
More simply referred to as a Duodenal Switch, this procedure could be classified as a Gastric Bypass/Gastric Sleeve combination with a twist….
- A large portion of the stomach is removed to create a cylinder-shaped pouch connecting the esophagus to the top of the small intestine.
- 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.
- 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.
- 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.
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. While other surgeries have been proven much more effective long-term in regards to the reintervention and reoperation rates, VBG is an acceptable alternative for those who aren’t a fit for other options.
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.
Mini gastric bypass surgery (MGBP)
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.
With the Roux-en-Y gastric bypass (RNY) reviewed above, there are two surgical attachments made…
- The small intestine is cut and attached to the small pouch (top part of the stomach)
- 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. The MGBP only uses one connection where the RNY uses two…
See our Mini Gastric Bypass Surgery page for all of the details.
Transoral Gastric Volume Reduction (TGVR)
Transoral Gastric Volume Reduction is a relatively new
restrictive procedure that has shown
encouraging
results.
It works by sewing the sides of the stomach to create a feeling of
fullness (it’s primarily restrictive) by not allowing the stomach to
relax.
According to Brigham and Women’s Hospital1, the organization who conducted the first-ever study on this new procedure…
“Under general anesthesia, the scope is inserted through the mouth and into the stomach. A series of two-or three-bite stitches are placed to appose the anterior and posterior gastric walls in the body and fundus, thereby reducing the expansible volume of the proximal stomach. Patients are typically able to return home approximately two hours following the procedure.”
More time and research are needed before we’ll feel comfortable recommending this procedure, but for now it looks promising. (Sign up for our Bariatric Surgery Blog to receive updates.)
Gastric Pacing (Implantable Gastric Stimulation)
Gastric pacing, or implantable gastric stimulation (IGS) is far from being proven as an effective treatment for obesity, but its potential impact on the field of bariatric surgery makes it worth noting.
Through an implanted device similar to a pacemaker, it is hypothesized to reduce appetite by sending electrical impulses to the stomach. The exact reasons that this could work are being investigated. (Sign up for our Bariatric Surgery Blog to receive updates.)
Comparison of the Types of Bariatric Surgery
(Use the scroll bar on the right to fill out all sections, then click the "Share Your Experience" button at the bottom. Your contribution will receive its very own web page on this site.)
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?
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 procedures below for more information) |
Category (explained above) | Average Long-Term Excess Weight Lost (approx. %) |
Comp- lication Rate | Research Ranking* (and reason if below ‘A’) | Average U.S. Cost (assuming no comp- lications) |
Covered by insurance and/or Medicare? | |
|---|---|---|---|---|---|---|---|
| *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 | $15,000 - $35,000 | Yes | |
| Gastric Banding (i.e. Lap Band) | Restrictive | Extremely variable – average is about 50%, but ranges from 25% to 80% | Up to 33% | A | $10,000 - $25,000 | Yes | |
| Biliopancreatic Diversion with Duodenal Switch (BPD/DS) | Mal- absorptive | 65% to 75% | Up to 24% | A | $20,000 - $30,000 (plus around $1,500 per year for bariatric vitamins) | Depends | |
| Vertical Banded Gastroplasty (VBG) | Restrictive | 50% to 60% | Up to 21% |
B
(good op- tion if others won’t work, but may be associated with more
long-term problems) |
$15,000 - $25,000 | Depends | |
| Gastric sleeve surgery (Vertical Sleeve Gastrectomy) | Restrictive | Needs
more long-term research. Studies conducted to date show 65% to 75% range. |
Up to 10% |
B
(looks pro- mising, but needs more research) |
$10,000 - $20,000 | Depends | |
| Mini gastric bypass surgery | Com- bination (primarily restrictive) | Needs
more research. Studies conducted to date show 60% to 70% range. |
Up to 8% |
C
(with the right sur- geon, research suggests this could be a
viable option, but you may want to avoid it until the controversy
surrounding this procedure is resolved) |
Normally $7,000 - $10,000 (but could be up to $17,000) |
No | |
| Transoral gastric volume reduction (TGVR) | Restrictive | Needs more research | n/a |
C
(very promising, but still too new) |
n/a | No | |
| Gastric Pacing | n/a | n/a | n/a |
D
(this techn- ology is something to look out
for, but for now its use as a weight loss tool has too many un- knowns) |
n/a | No | |
summary
of positives
and negatives of all types of bariatric
surgery
(click links below to
Jump to pages dedicated to each surgery)
Following is a comparison of the five procedures that have received a research ranking of ‘A’ or ‘B’. It doesn’t 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.
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 level of risk, it may be the best procedure for those with a body mass index of 40 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.
Vertical Banded Gastroplasty ("Stomach Stapling")
Vertical Banded Gastroplasty (stomach stapling) has been around the longest, so there may be more surgeons out there with experience performing it.
While initial weight loss and improvement in co-morbidities is good, the longer hospital stays, higher complication rates and required diet following surgery make other procedures more viable for most patients.
Keep in mind that it could still be right for some patients, especially when medical conditions make other procedures unsafe.
Gastric Sleeve (Vertical Sleeve Gastrectomy)
We are extremely excited by the data presented so far for gastric sleeve surgery, but more long-term research is needed to verify the short-term results. The gastric sleeve appears to carry the low risks of gastric banding with the higher weight loss associated with gastric bypass.
The main fear is that the pouch could stretch over time, and the long staple line could cause problems.
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 lost 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.
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 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.
Vertical banded gastroplasty has some positives, especially for patients with certain health problems. But in general, its risks may be too high to justify the rewards.
While gastric sleeve surgery needs more long-term research, its track record as a first-step procedure and its stand-alone short-term results led us to elevate its Research Ranking to 'B'.
YOUR Weight Loss Journey
Help visitors like you by sharing your advice related to this page or other topics...
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Mini gastric bypass surgery and Transoral Gastric Volume Reduction both look like promising types of bariatric surgery, but neither has 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).
From a payment perspective, bariatric surgery insurance will typically only cover gastric bypass, lap band and/or duodenal switch surgery. Weight loss surgery financing programs are available for most bariatric procedures.
For additional research, search for your topic of interest...
Also see...
- Financing Bariatric Surgery
- Bariatric Vitamins - comparing which vitamins and supplements you'll need after each surgery
- Bariatric Surgery Complications (compares the risks and complications for all of the procedures reviewed on this page)
- Bariatric Doctors (will help you find, interview and choose the right surgeon)
Back to Bariatric Surgery Source Home Page from Types of Bariatric Surgery
References
- 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.
- 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.
