of Positives & Negatives of Established Weight Loss Surgery Procedures
(click links below to
jump to pages dedicated to each surgery)
Following is a comparison of the established types of bariatric surgery…
Roux-en-Y Gastric Bypass
Patients typically don’t lose as much weight after laparoscopic
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 (and more consistent among patients) than
what is expected following gastric banding.
The presence of dumping
syndrome is a significant difference
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
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)
band surgery has an impressively low rate of serious
and is the only well-researched surgery that is completely reversible (note: we’re keeping an eye on the investigational gastric plication surgery).
While the average 50% of excess weight lost is a decent
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
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 adjustable gastric banding 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.
Diversion with Duodenal Switch, or
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
And although it carries the highest risk of complications, it’s mortality risks are on par with other procedures and it may be
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
malabsorption that it causes command careful consideration by the
patient and surgeon before moving forward.
Gastric Sleeve (Vertical Sleeve Gastrectomy)
sleeve surgery has recently caught 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 curing type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis.4
The main concern is
that the pouch could stretch over time, although there are several minimally invasive options available for reducing the pouch size down the road if necessary.
Intragastric Balloon (Gastric Balloon)
The gastric balloon is the newest member of the "most common weight loss surgery procedures" family. It can be thought of the procedure that "bridges the gap" between pure diet and exercise and the more aggressive bariatric surgery procedures reviewed above. It is the only procedure of the group that is non-invasive; the balloon is inserted into the stomach through the mouth rather than requiring surgery. Its less aggressive nature also results in lower risk and lower weight loss than the other procedures.
Since most types of balloons must be removed after 6 months, this should be considered a short-term option to either jump-start a more intensive diet and exercise program or as a way to lose weight before one of the more aggressive procedures to reduce the risk of complications.
The intragastric balloon has not been around as long as the others. As a result, more long-term studies are needed before we’ll feel comfortable elevating the procedure from a ‘B’ to an ‘A’ research ranking.
However, current study results are promising, especially if your expectations about weight loss and the long-term affect are appropriate.
Your individual situation will determine which types of bariatric surgery are
you, but following is a general summary…
Roux-en-Y Gastric bypass 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.
band surgery is a better option for some
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
the only established procedure that is completely reversible; it can be relatively easily converted into a more elaborate
procedure at a later date.
Unfortunately, lap band surgery has a very high variability
in weight loss from patient to patient, and is associated with more
minor and annoying complications. Most concerningly, lap band surgery is much more likely to require reoperation over the long-term as a result of permanent failure.
switch is probably the most effective procedure
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
sleeve surgery is less complicated than gastric bypass and duodenal switch and leads to similar weight loss.
While not reversible or easily adjustable 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.
During our Annual Weight Loss Surgery Cost Survey, when we speak directly with literally hundreds of surgical practices all over the world, we discovered that the majority of practicing surgeons are now recommending gastric sleeve surgery more often than any of the other more established procedures.
The intragastric balloon procedure appears to be a good "middle of the road" option: more aggressive than diet and exercise but less aggressive than traditional weight loss surgery. It is the first such procedure to receive broad acceptance by surgeons around the world.
If you are not comfortable taking the leap into a more permanent procedure and are mindful of its short-term nature, this may be an option to consider. Remember, if your habits revert back after the balloon is removed, your time, effort and money will be wasted. But if you are committed to a long-term change and are looking for something to "jump start" your efforts, the balloon provides that option.