7 Types of Weight Loss Surgery - How Each Will Affect You

Reviewed by:  

John Rabkin, MD

Last Updated:  

06/28/2017

There are 7 types of weight loss surgery (also called “bariatric surgery”) available, including:

  • Gastric Sleeve – feel less hungry & full sooner while eating
  • Gastric Bypass – feel full sooner while eating & absorb fewer minerals
  • Duodenal Switch – feel less hungry & full sooner while eating, absorb fewer calories and minerals
  • LAP-BAND® – feel full sooner while eating
  • Gastric Balloon – temporarily feel full sooner while eating (balloon removed after 6 months)
  • vBloc Therapy – feel full between meals & less hungry while eating
  • AspireAssist – drain a portion of stomach contents after eating

There is no “one size fits all” procedure, so this page will help you determine which ones best fit your goals.

01Procedure Options
  • Choose from 7 weight loss procedures

Most Popular Procedure

  • Winner: Gastric Sleeve

  • Runner 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 (e.g., 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
    • Mini Gastric Bypass Surgery (MGBP)
  • 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 experimental procedures which can be reviewed on our Experimental Weight Loss Surgery page.

Rejected & Outdated Procedures

One other procedure is no longer performed since the options above result in superior results and/or less risk:

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

gastric sleeve surgery
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

gastric bypass surgery
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)

Duodenal Switch Surgery (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.
    In short, if you’re interested in the DS, find an experienced DS surgeon and cross the bypass vs. DS complication rate debate off your list of concerns.

Is Dumping Syndrome Always a Bad Thing?

For about 95% of patients experiencing dumping syndrome, symptoms are relatively minor (1). Symptoms may include weakness, dizziness, flushing and warmth, nausea, and palpitation immediately or shortly after eating. They are caused by abnormally rapid emptying of the stomach, especially in individuals who have had part of the stomach removed.

While this sounds like a bad thing, many patients view it as a “blessing in disguise.” The symptoms of dumping syndrome are completely avoidable by eating a proper bariatric diet. Can you think of a more convincing way to keep you on track? In fact, some patients who do not suffer from dumping syndrome often comment that they wish they did, as “dumping” removes some of the choice involved in food selections. See our Dumping Syndrome page for more details.

LAP-BAND®

Lap-Band-Surgery
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.

The gastric 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

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

Intragastric 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.

AspireAssist Device

Why the AspireAssist Works
  • A tube similar to a feeding tube is inserted into the stomach and attached to a port on the outside of the abdomen. A device is then attached to this port and used to drain a portion of the stomach’s contents before digestion.
How the AspireAssist Tube is Inserted

The AspireAssist Tube is inserted as follows:

  • An endoscope is inserted in your mouth and passed through to your stomach.
  • A small incision is made in your abdomen and a wire is passed through the incision into your stomach.
  • The endoscope grabs the wire, and then both the endoscope and wire are pulled back out of your mouth.
  • The “A-Tube” is then attached to the wire, and both are pulled back into your stomach and out the incision in your abdomen until the tip of the tube exits your incision.
  • After your incision has healed you will need to go back to the doctor for a very quick procedure to attach your Skin-Port.

02Weight Loss
  • Ranges from 25% to 90% of your excess weight, depending on the procedure

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.

Excess Weight Loss by Procedure

The following graph and chart compare weight loss over time for each procedure:

 
 
Gastric Sleeve
Gastric Sleeve
Gastric Bypass
Gastric Bypass
Gastric Balloon
Gastric Balloon
Duode­nal Switch
Duode­nal Switch
LAP-BAND®
LAP-BAND®
vBloc Therapy
vBloc Therapy
Aspire Assist
Aspire Assist
 
3 Months
Gastric Sleeve
30%
Gastric Bypass
30%
Gastric Balloon
15%
Duode­nal Switch
30%
LAP-BAND®
20%
vBloc Therapy
10%
Aspire Assist
8%
 
6 Months
Gastric Sleeve
50%
Gastric Bypass
50%
Gastric Balloon
30%
Duode­nal Switch
45%
LAP-BAND®
30%
vBloc Therapy
20%
Aspire Assist
15%
 
1 Year
Gastric Sleeve
70%
Gastric Bypass
65%
Gastric Balloon
varies (balloon remov­ed after 6 mo)
Duode­nal Switch
65%
LAP-BAND®
40%
vBloc Therapy
25%
Aspire Assist
30%
 
2 Years
Gastric Sleeve
65%
Gastric Bypass
60%
Gastric Balloon
varies (balloon remov­ed after 6 mo)
Duode­nal Switch
70%
LAP-BAND®
55%
vBloc Therapy
25%
Aspire Assist
no data yet
 
3 Years
Gastric Sleeve
60%
Gastric Bypass
60%
Gastric Balloon
varies (balloon remov­ed after 6 mo)
Duode­nal Switch
70%
LAP-BAND®
55%
vBloc Therapy
25%
Aspire Assist
no data yet
 
5 Years
Gastric Sleeve
55%
Gastric Bypass
60%
Gastric Balloon
varies (balloon remov­ed after 6 mo)
Duode­nal Switch
70%
LAP-BAND®
55%
vBloc Therapy
25%
Aspire Assist
no data yet
 
8 Years
Gastric Sleeve
56%
Gastric Bypass
no data yet
Gastric Balloon
no data yet
Duode­nal Switch
no data yet
LAP-BAND®
no data yet
vBloc Therapy
no data yet
Aspire Assist
no data yet
 
11 Years
Gastric Sleeve
62.5%
Gastric Bypass
no data yet
Gastric Balloon
no data yet
Duode­nal Switch
no data yet
LAP-BAND®
no data yet
vBloc Therapy
no data yet
Aspire Assist
no data yet

References: (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) (29) (30)

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03Health Benefits
  • Cures or improves diabetes, sleep apnea, hypertension, and at least 12 other conditions, depending on the procedure

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 (2).

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.

Compare Health Improvement

The following table compares available studies for all procedures and conditions:

Co-morbidity
Co-morbidity
Dyslipidemia hyperchole­sterolemia
Dyslipidemia hyperchole­sterolemia
Diabetes
Diabetes
Hyperli­pidemia (high levels of fat in the blood, high cholesterol)
Hyperli­pidemia (high levels of fat in the blood, high cholesterol)
High Blood Pressure (hyper­tension)
High Blood Pressure (hyper­tension)
Joint/Bone Disease (osteoar­thropathy)
Joint/Bone Disease (osteoar­thropathy)
Depression
Depression
Migraines
Migraines
Pseudo­tumor cerebri
Pseudo­tumor cerebri
Cardiova­scular Disease
Cardiova­scular Disease
Venous Stasis Disease
Venous Stasis Disease
Gastroeso­phageal Reflux Disease (GERD)
Gastroeso­phageal Reflux Disease (GERD)
Non-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease
Mortality Reduction/ Life Expectancy (5 year mortality)
Mortality Reduction/ Life Expectancy (5 year mortality)
Quality of Life Improve­ments
Quality of Life Improve­ments
Metabolic Syndrome
Metabolic Syndrome
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome
Pregnancy
Pregnancy
Asthma
Asthma
Obstructive Sleep Apnea
Obstructive Sleep Apnea
Stress Urinary Inconti­nence
Stress Urinary Incontinence
Co-morbidity
Gastric Balloon % Improved /Resolved
Dyslipidemia hypercholesterolemia
10%
Diabetes
33%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
34%
High Blood Pressure (hypertension)
45%
Joint/Bone Disease (osteoarthropathy)
48%
Depression
 
Migraines
 
Pseudotumor cerebri
 
Cardiovascular Disease
 
Venous Stasis Disease
 
Gastroesophageal Reflux Disease (GERD)
 
Non-Alcoholic Fatty Liver Disease
 
Mortality Reduction/ Life Expectancy (5 year mortality)
 
Quality of Life Improvements
 
Metabolic Syndrome
 
Polycystic Ovarian Syndrome
 
Pregnancy
 
Asthma
 
Obstructive Sleep Apnea
 
Stress Urinary Incontinence
 
Co-morbidity
Gastric Sleeve % Improved /Resolved
Dyslipidemia hypercholesterolemia
64%
Diabetes
55%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
35%
High Blood Pressure (hypertension)
68%
Joint/Bone Disease (osteoarthropathy)
46%
Depression
Most
Migraines
40%
Pseudotumor cerebri
n/a
Cardiovascular Disease
100%
Venous Stasis Disease
95%
Gastroesophageal Reflux Disease (GERD)
50%
Non-Alcoholic Fatty Liver Disease
n/a
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
93%
Metabolic Syndrome
62%
Polycystic Ovarian Syndrome
Most
Pregnancy
Most
Asthma
90%
Obstructive Sleep Apnea
62%
Stress Urinary Incontinence
90%
Co-morbidity
Bypass % Improved /Resolved
Dyslipidemia hypercholesterolemia
63%
Diabetes
83%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
73%
High Blood Pressure (hypertension)
69%
Joint/Bone Disease (osteoarthropathy)
43%
Depression
Most
Migraines
57%
Pseudotumor cerebri
96%
Cardiovascular Disease
79%
Venous Stasis Disease
95%
Gastroesophageal Reflux Disease (GERD)
80%
Non-Alcoholic Fatty Liver Disease
90%
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
95%
Metabolic Syndrome
80%
Polycystic Ovarian Syndrome
Most
Pregnancy
Most
Asthma
80%
Obstructive Sleep Apnea
98%
Stress Urinary Incontinence
88%
Co-morbidity
DS % Improved /Resolved
Dyslipidemia hypercholesterolemia
99%
Diabetes
92%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
99%
High Blood Pressure (hypertension)
83%
Joint/Bone Disease (osteoarthropathy)
43%
Depression
Most
Migraines
Most
Pseudotumor cerebri
Cardiovascular Disease
86%
Venous Stasis Disease
Gastroesophageal Reflux Disease (GERD)
49%
Non-Alcoholic Fatty Liver Disease
99%
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
95%
Metabolic Syndrome
99%
Polycystic Ovarian Syndrome
Most
Pregnancy
Asthma
90%
Obstructive Sleep Apnea
99%
Stress Urinary Incontinence
Co-morbidity
vBloc % Improved /Resolved
Dyslipidemia hypercholesterolemia
Diabetes
Moderate
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
High Blood Pressure (hypertension)
Joint/Bone Disease (osteoarthropathy)
Depression
Migraines
Pseudotumor cerebri
Cardiovascular Disease
Moderate
Venous Stasis Disease
Gastroesophageal Reflux Disease (GERD)
Non-Alcoholic Fatty Liver Disease
Mortality Reduction/Life Expectancy (5 year mortality)
Quality of Life Improvements
Metabolic Syndrome
Polycystic Ovarian Syndrome
Pregnancy
Asthma
Obstructive Sleep Apnea
Stress Urinary Incontinence
Co-morbidity
Band % Improved /Resolved
Dyslipidemia hypercholesterolemia
70%
Diabetes
60%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
23%
High Blood Pressure (hypertension)
43%
Joint/Bone Disease (osteoarthropathy)
81%
Depression
57%
Migraines
Some
Pseudotumor cerebri
Most
Cardiovascular Disease
73%
Venous Stasis Disease
Gastroesophageal Reflux Disease (GERD)
87%
Non-Alcoholic Fatty Liver Disease
Most
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
Most
Metabolic Syndrome
78%
Polycystic Ovarian Syndrome
48%
Pregnancy
Most
Asthma
82%
Obstructive Sleep Apnea
85%
Stress Urinary Incontinence
82%
Co-morbidity
AsipreAssist % Improved/ Resolved
Dyslipidemia hypercholesterolemia
 
Diabetes
Possible improve­ment
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
Possible improve­ment
High Blood Pressure (hypertension)
Possible improve­ment
Joint/Bone Disease (osteoarthropathy)
 
Depression
 
Migraines
 
Pseudotumor cerebri
 
Cardiovascular Disease
 
Venous Stasis Disease
 
Gastroesophageal Reflux Disease (GERD)
 
Non-Alcoholic Fatty Liver Disease
 
Mortality Reduction/Life Expectancy (5 year mortality)
 
Quality of Life Improvements
 
Metabolic Syndrome
 
Polycystic Ovarian Syndrome
 
Pregnancy
 
Asthma
 
Obstructive Sleep Apnea
 
Stress Urinary Incontinence
 

04Qualify
  • Minimum body mass index (BMI) of 30 is required (varies by procedure)
  • Click here to calculate your BMI

Easiest to Qualify

  • Winner: No Clear Winner

In order to qualify for any type of weight loss surgery, your body mass index (BMI) must fall within a certain range.

The following procedures have a limited acceptable range:
  • Gastric balloon: Accepts BMIs from 30 to 40
  • vBloc Therapy: Accepts BMIs from 35 to 45
  • AspireAssist: Accepts BMIs from 35 to 55

The rest of the procedures (gastric sleeve, gastric bypass, duodenal switch, and gastric banding) have the same qualification requirements:

  • Body mass index 40 or above or
  • Body mass index from 35 to 40 as long as you have a serious obesity-related health problem (“comorbidity”) such as diabetes, asthma, hypertension, joint problems, sleep apnea, or one of many others.
  • Body mass index from 30 to 35 may be accepted if certain health issues are present

Use the BMI Calculator below to determine your body mass index.

05Insurance
  • Gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch are covered if your policy includes bariatric surgery
  • Click here to check your insurance

Insurance Coverage

  • Winner: (4-Way Tie) Sleeve, Bypass, Band, & Duodenal Switch

For insurance policies that include weight loss surgery, four procedures are currently covered:

  • Gastric sleeve surgery
  • Gastric bypass surgery
  • Duodenal switch surgery (biliopancreatic diversion with duodenal switch)
  • Gastric banding (LAP-BAND® surgery)

The weight loss surgery insurance approval process can take anywhere from 1 to 12 months, depending on your insurance company and your situation.

Following are the typical steps:

  1. Confirm with your doctor that your body mass index and health conditions fall within one of the two qualification requirements:
    • BMI over 40 –OR–
    • BMI over 35 with one or more of the following:
      • Clinically significant obstructive sleep apnea
      • Coronary heart disease
      • Medically refractory hypertension
      • Type 2 diabetes mellitus
      • Other obesity-related health issues
  2. Complete 3 to 7 consecutive months of a medically supervised diet program, depending on your insurance company (can be coordinated by your bariatric surgeon).
  3. Schedule a consultation with your bariatric surgeon.
  4. Schedule a consultation with your primary care physician to obtain a medical clearance letter.
  5. Schedule a psychiatric evaluation to obtain a mental health clearance letter (usually coordinated by your bariatric surgeon).
  6. Schedule a nutritional evaluation from a Registered Dietitian (usually coordinated by your bariatric surgeon).
  7. Send all of the above documentation to your insurance company along with a detailed history of your obesity-related health problems, difficulties, and treatment attempts. The review process typically happens in under one month (usually coordinated by your bariatric surgeon).
  8. Insurance company sends approval or denial letter:
    • If approved, your surgeon’s bariatric coordinator will contact you for scheduling.
    • If denied, you can choose to appeal the denial.

Take the Easy Route – Your surgeon’s office will do most of this leg-work for you. They will be highly experienced in managing the process and may even have all of the required personnel on staff (e.g. registered dietitian, psychiatrist, bariatric coordinator, etc.).

Click here to access the weight loss surgeon directory to get started. Most offices will check your insurance for free to confirm coverage criteria.

For more information about weight loss surgery insurance, see our Bariatric Surgery Insurance Guide.

06Cost Without Insurance
  • Total Cost: $19,000, on average
  • Loan Payment: $445/month, on average
  • Discounts & Tax Savings: Usually available

Low-Cost Procedure (Without Insurance)

  • Winner: Gastric Balloon (but long-term costs likely higher than more expensive procedures)

  • Runner Up: LAP-BAND®

Low-Cost Procedure (With Insurance)

  • Winner: 4-Way Tie – Gastric Sleeve, Gastric Bypass, Duodenal Switch, & LAP-BAND®

  • Runner Up: Gastric Balloon

The cost of surgery should not dictate which procedure you have. Through research and consultation with your surgeon, you should move forward with the procedure that is most likely to work for you.

Still, if you don’t have insurance that covers bariatric surgery, it’s important to know what you’re up against financially.

*There are a few key caveats to the cost information and winners above:

  • The above costs are averages. Actual costs vary widely depending on the region, hospital, and surgeon.
  • These costs are not necessarily all inclusive.Talk with your surgeon or hospital for a more specific quote.
  • Long-term costs will probably be much lower for the more expensive procedures. Even though they are not declared “Low-Cost Winners” in this section, the more expensive procedures tend to do a much better job at improving or resolving obesity-related health problems which will save you more money over the long-term. More on this in the “Cost of Not Having Surgery” sub-section below.

Financing

Regardless of which procedure you choose, financing is available to many patients to help make surgery more affordable.

Please visit our Financing weight loss surgery page for all the possible ways to finance your surgery.

Cost of Not Having Surgery vs. Cost of Weight Loss Surgery

Even if you’re paying out of pocket, the cost of any procedure is far less than the long-term costs of obesity-related health problems for morbidly obese people who don’t have surgery.

On average, weight loss surgery patients pay off their entire surgery and start getting ahead financially after only 2 years (3).

To illustrate: One study found that bariatric patients pay as much as $900 less per month as soon as 13 months after surgery than similar people who didn’t have surgery (4). Starting in month 13, that’s almost $11,000 saved per year in total medical costs.

Fewer prescription drugs alone have been found to save patients $3,000 or more per year (5).

07Recovery
  • Hospital Stay: 0 to 3 days, depending on procedure
  • Time Off Work: 2 days to 2 weeks, depending on procedure
  • Full Recovery: 3 days to 6 weeks, depending on procedure
  • Pain: Same as any laparoscopic procedure (except balloon, which requires no incisions)
  • Diet & Activity: Slow transition back to normal

Quickest Recovery

  • Winner: (Tie) vBloc Therapy, Gastric Balloon & AspireAssist

  • Runner 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).

Less Involved Procedures

  • Gastric balloon
  • vBloc Therapy
  • AspireAssist

The less involved procedures, including gastric balloon and vBloc Therapy, have the shortest hospital times (return home the same day as surgery) and recovery times (back to work in 3 to 4 days).

More Involved Procedures

  • LAP-BAND®
  • Gastric sleeve
  • Gastric bypass
  • Duodenal switch

The moderately involved procedure, LAP-BAND®, will require a 1 day hospital stay and will have you back to work in 2 weeks.

The most involved procedures, including gastric sleeve, gastric bypass, and duodenal switch, typically require 2 to 3 days in the hospital, although you should still be able to return to work within 2 weeks.

Recovery: What to Expect

For all procedures except gastric balloon and AspireAssist, here’s what to expect during your hospital stay and recovery:

  1. Wake Up: When you first awake after surgery, you’ll be sore and a little “out of it.” You’ll be on medication to control the pain.
  2. Move Around: Your surgeon will have you up and walking around as soon as possible after you wake up to reduce the risk of blood clots and jump-start your body’s healing process. Continue to walk as much as possible, increasing it a little each day.
  3. Get Released: Before releasing you, your surgical team will run a number of tests to ensure:
    • You are able to drink enough to stay hydrated
    • You can urinate normally after your catheter is removed
    • You have adequate pain relief from your pain meds
  4. Look for Warning Signs: Warning signs vary by procedure. Call your surgeon immediately if you experience any of the following:
    • Fever
    • No improvement or worsening of pain
    • Signs of incision infection (pus, swelling, heat, or redness)
    • Difficulty swallowing
    • Ongoing nausea or vomiting
  5. Transition Your Diet: Since you’ll be eating less, you may feel tired and lethargic until your body adjusts. For all procedures other than vBloc and gastric balloon, your smaller or constricted stomach will be sensitive, especially at first. You’ll be on a liquid diet for a couple of weeks before slowly transitioning back to solid foods (read more about this in the Diet & Life After section of this page).
  6. Ease Off Medications: Your surgeon will prescribe pain and digestion medication as needed and may adjust your pre-surgery medications until you’re fully healed. Follow their instructions to the letter.
  7. Return to Your “New Normal” Life: Avoid swimming or bathing until your incisions have fully healed. Many patients return to normal life and work within a couple of weeks, but plan for up to 4 to 6 weeks off to be on the safe side. Full exercise and heavy lifting typically resume within one to two months.
  8. Have Follow-Up Visits During First Year: Follow-ups with your surgeon’s team will happen about one week post-op, then around 4 weeks post-op, then every 3 or 4 months to ensure that everything is on track, including:
    • Discuss weight loss
    • Encourage regular exercise
    • Obtain lab work and make necessary adjustments to medications and dietary supplements
    • Understand diet and identify any potential eating disorders
    • Determine whether any potential complications may be arising
    • Monitor status of obesity-related health issues
    • Involve your family physician to help evaluate progress and ensure a successful transition
  9. Transition to Semi-Annual or Yearly Follow-Up Visits: After you’ve reached your “low point” weight, your surgeon will probably still want to see you at least once per year (6). During those visits you may meet with several team members, including your surgeon, dietitian, and mental health care provider. They will probably request lab work to ensure that vitamin levels and other indicators are where they should be. If you experience any issues in between visits, don’t wait for your next visit… call your doctor right away.

Gastric balloon surgery recovery is unique in that it does not require any incisions. As a result, recovery is much faster than after the more involved procedure and generally focuses on diet changes:

  1. Day 1 – Clear Liquids Only
  2. Days 2 through 7 – Liquid Diet
  3. Days 7 through 14 – Pureed Food Diet
  4. Days 15+ – “New Normal” Diet – Restrictions include foods that may stick to your balloon, such as pasta. Sip water after you eat to rinse your balloon.

AspireAssist insertion recovery is unique because it is a relatively simple procedure requiring less time for recovery and does not necessarily require any long-term diet restrictions.

The procedure usually takes about 15 minutes and you should be able to return to your regular routine in about 3 days.

Because food will need to fit through the newly inserted tube your initial diet will be:

  • Week One – pureed food or non-chunky soup
  • Week Two – soft foods like bananas or pasta
  • After Week Two – new healthy diet recommended by your surgeon/dietitian

08Diet & Life After
  • Ranges from "No Restrictions" to "Restricted with Supplementation," depending on procedure
  • Regular Exercise
  • Personal relationships may change

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.

Food & Drink: Varies by Procedure

The more involved procedures, including gastric sleeve, gastric bypass, duodenal switch, and LAP-BAND®, have very similar diet requirements before and after surgery. Gastric balloon, vBloc Therapy, and AspireAssist have their own guidelines.

The following sections compare each aspect of your diet after surgery.

Diet Stages & Timing By Procedure

Following is a general overview and timing of each stage before and after surgery:

 
 
Practice your post-surgery diet
Practice your post-surgery diet
High protein, low sugar, low carbs
High protein, low sugar, low carbs
Stop or change some medications
Stop or change some medications
Clear liquids only
Clear liquids only
Nothing to eat or drink
Nothing to eat or drink
Sugar-free clear liquids only
Sugar-free clear liquids only
Add thicker drinks & smooth foods
Add thicker drinks & smooth foods
Slowly test pureed foods & soft solid foods
Slowly test pureed foods & soft solid foods
Slowly test solid foods
Slowly test solid foods
 
Sleeve, Bypass, DS, Band
Practice your post-surgery diet
2+ Weeks Before
High protein, low sugar, low carbs
2 Weeks Before
Stop or change some medications
1 Week Before
Clear liquids only
2 Days Before
Nothing to eat or drink
Midnight Before Surgery
Sugar-free clear liquids only
In Hospital to 7 Days After Surgery (Varies by Surgeon)
Add thicker drinks & smooth foods
Day 1 to Week 2 After Surgery (Varies by Surgeon)
Slowly test pureed foods & soft solid foods
Day 2 to Week 3 After Surgery (Varies by Surgeon)
Slowly test solid foods
Day 3 to Weeks 4+ After Surgery (Varies by Surgeon)
 
vBloc
Practice your post-surgery diet
High protein, low sugar, low carbs
Stop or change some medications
Clear liquids only
Nothing to eat or drink
Midnight Before Until After Surgery
Sugar-free clear liquids only
Until After Surgery
Add thicker drinks & smooth foods
Slowly test pureed foods & soft solid foods
Slowly test solid foods
 
Balloon
Practice your post-surgery diet
2+ Weeks Before
High protein, low sugar, low carbs
Stop or change some medications
Clear liquids only
Nothing to eat or drink
Midnight Before Until After Balloon Placement
Sugar-free clear liquids only
Until After Balloon Placement
Add thicker drinks & smooth foods
Day 2 through 7
Slowly test pureed foods & soft solid foods
Day 6 through 14
Slowly test solid foods
Weeks 3+
 
AspireAssist
Practice your post-surgery diet
High protein, low sugar, low carbs
Stop or change some medications
Clear liquids only
Nothing to eat or drink
Midnight Before Until After Tube Placement
Sugar-free clear liquids only
In Hospital to 7 Days After Surgery (Varies by Surgeon)
Add thicker drinks & smooth foods
Slowly test pureed foods & soft solid foods
Day 1 to Week 2 After Surgery (Varies by Surgeon)
Slowly test solid foods
After Week 2

Foods to Avoid By Procedure

For all procedures other than vBloc Therapy and the AspireAssist, your dietitian is likely to recommend the following:

  • Test one food at a time to make sure you can tolerate it
  • Eat proteins first, in solid form (e.g. not protein shakes)
  • Eat healthy “whole” foods
  • Avoid processed foods
  • Avoid sugary foods or drinks
  • Eat slowly and chew thoroughly
  • No starchy foods like rice, bread, and pasta
  • Avoid any food that is difficult to digest (may be able to tolerate over time), such as:
    • Fibrous vegetables like broccoli, celery, and corn
    • Nuts
    • Seeds
    • Skin of any meat
    • Tough meats
  • Avoid whole milk products
  • Drink 64+ oz (2+ liters) of fluids spread throughout the day
  • No drinking 30 minutes before or after meals (other than gastric balloon)
  • Alcohol only in moderation

In addition to the above, following are procedure-specific foods to avoid:

  • Gastric bypass
    • Avoid foods that are likely to cause dumping, including sugar, unnecessary fat, or refined carbohydrates.
    • Patients who undergo the bypass procedure are at especially high risk of developing Alcohol Use Disorder (AUD) (7) (8) (9).
  • Gastric balloon
    • Avoid foods that may stick to your balloon and cause vomiting, such as pasta. To reduce risk of vomiting, drink liquids after eating to rinse your balloon.

Vitamins & Supplements

All Types of Bariatric Surgery

Since you will be eating less after any type of weight loss surgery, you will likely need to supplement your diet with:

  • Daily multivitamin
    • 1 to 2 per day, forever
    • Chewable or liquid versions are best (instead of tablets)
    • Take with food (except dairy) to maximize absorption
    • At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium and zinc
  • Daily calcium supplement, in the form of calcium citrate
    • Must be calcium citrate (NOT other forms of calcium)
    • 1000-1500 mg. daily, forever
    • Chewable and liquid versions are best (instead of tablets)
    • Try to find one that includes Vitamin D
    • Take 2 hours apart from Iron supplements (or Multivitamin that contains Iron) to maximize absorption

Gastric Sleeve, Gastric Bypass, Duodenal Switch, & LAP-BAND® Only

The more involved procedures, including the sleeve, bypass, DS, and band, may also require one or more of the following supplements, depending on your situation:

  • Folate (folic acid)
  • Iron
  • Thiamin (Vitamin B1)
  • Vitamin D

Gastric Bypass and Duodenal Switch Only

In addition to the above, Thiamin (Vitamin B1) supplementation is more likely to be required after gastric bypass and DS surgery given their higher levels of malabsorption than the other procedures.

Duodenal Switch Only

In addition to all of the above, since DS surgery is the only true malabsorptive procedure (malabsorption of calories, minerals, and fat-soluble vitamins vs only minerals after gastric bypass), DS patients also require daily fat-soluble vitamin supplements (including Vitamins A, D, E, and K).

This will typically include one additional tablet taken 3 times each day.

AspireAssist

As part of your follow up visits your surgeon will continue to monitor your nutrition levels. It is possible your surgeon will recommend you take additional vitamins if she determines you are not getting enough nutrients due to aspiration.

Exercise: Same for All Procedures

Following recovery, exercise should be the same for all procedures: 2.5 hours per week, spread out over 2 to 4 days. Keep in mind that patients who exercise regularly:

  • Lose more weight
  • Are more physically and mentally healthy

Learn more on our Exercise After Weight Loss Surgery page.

Your Brain: Less Hungry After Some Procedures, Careful About Food Addiction

Reduced Hunger: Sleeve, DS, & vBloc Therapy

You may feel less hungry following the 2 procedures that completely remove a large portion of the stomach – gastric sleeve and duodenal switch.

When your stomach is empty, it secretes a hormone called ghrelin into your bloodstream which causes your brain to generate hunger impulses. After you eat, the amount of secreted ghrelin drops then slowly rises until your next meal. Since your stomach will be significantly smaller following these two procedures, the amount of ghrelin the stomach secretes – and your resulting feelings of hunger – may also go down.

vBloc Therapy is all about controlling hunger but goes about it differently. Instead of removing part of the stomach to control hormones, it uses an implanted device to block hunger signals altogether during certain parts of the day.

The other procedures leave the stomach in place and do not utilize a hunger-blocking device, so changes to hunger will remain largely unaffected.

Food Addiction

Regardless of which procedure you have, food addiction could be a problem.

Our bodies secrete certain hormones, like ghrelin mentioned above, that tell us when we’re hungry and full, but hyperpalatable food (like junk food) may be overriding those hormone signals by overstimulating our reward centers, much like our bodies and brains react to an addictive drug.

You may have a bona fide food addiction if your desire for food takes priority over other parts of your life that you acknowledge to be more important, such as personal health, family, friends, work, your appearance, or avoiding obesity related health issues like hypertension, sleep apnea, or diabetes.

If left unchecked, food addiction can lead to obesity. For weight loss surgery patients, if not addressed prior to surgery, it can also lead to weight regain.

To find out if you may be suffering from food addiction, take our Food Addiction Quiz.

Relationships After Weight Loss

Significant weight loss after any type of bariatric surgery can lead to big changes with everyone around you.

While many of those changes are positive, some can also be extremely challenging and unexpected.

See our Relationships After Weight Loss Surgery page for important changes to prepare for.

09Downsides
  • Low to moderate risk of non-serious complications
  • Side effects may include digestion issues & sagging skin from rapid weight loss
  • Weight regain is possible

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.

Expand Complications Chart

Issue
Issue
Abdominal Discomfort
Abdominal Discomfort
Abdominal hernia
Abdominal hernia
Abscess
Abscess
Anemia
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Blood Clots
Body Aches
Body Aches
Body Feeling Changes
Body Feeling Changes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Bowel Obstruction
Bowel Obstruction
Deep Vein Thrombosis
Deep Vein Thrombosis
Dehy­dration
Dehy­dration
Dental Problems
Dental Problems
Dumping Syndrome
Dumping Syndrome
Dyspepsia (Indigestion)
Dyspepsia (Indigestion)
Esophageal Dilation
Esophageal Dilation
Esophagitis
Esophagitis
Eviscera­tion & Incisional Hernia
Eviscera­tion & Incisional Hernia
Food Trapping
Food Trapping
Gallstones
Gallstones
Gastric Fistula
Gastric Fistula
Gastritis
Gastritis
Gastroeso­phageal Reflux Disease (GERD)
Gastroeso­phageal Reflux Disease (GERD)
Gastroin­testinal Leaks
Gastroin­testinal Leaks
General Anesthesia Complica­tions
General Anesthesia Complica­tions
Hair Loss
Hair Loss
Heart Attack
Heart Attack
Hemorr­hage (Bleeding)
Hemorr­hage (Bleeding)
Hiatal Hernia
Hiatal Hernia
Hypogly­cemia
Hypogly­cemia
Infection
Infection
Intole­rance to Certain Foods
Intole­rance to Certain Foods
Kidney Stones
Kidney Stones
Marginal Ulcers
Marginal Ulcers
Nausea, Vomiting and/or Stomach Cramps
Nausea, Vomiting and/or Stomach Cramps
Organ Injury During Surgery
Organ Injury During Surgery
Peritonitis
Peritonitis
Pneumonia
Pneumonia
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pouch Dila­tion
Pulmonary Embolism
Pulmonary Embolism
Respira­tory Failure
Respira­tory Failure
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Stenosis/­Stricture
Stenosis/­Stricture
Stoma Obstruc­tion
Stoma Obstruc­tion
Stroke
Stroke
Thrombo­phlebitis
Thrombo­phlebitis
Thrush (Yeast Infec­tion)
Thrush (Yeast Infec­tion)
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Weight Regain
Weight Regain
Wound Reopen­ing
Wound Reopen­ing
Wound Sepsis
Wound Sepsis
Issue
Complica­tion or Side Effect
Abdominal Discomfort
Side Effect
Abdominal hernia
Complica­tion
Abscess
Complica­tion
Anemia
Side Effect
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Complica­tion
Blood Clots
Complica­tion
Body Aches
Side Effect
Body Feeling Changes
Side Effect
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Side Effect
Bowel Obstruction
Complica­tion
Deep Vein Thrombosis
Complica­tion
Dehy­dration
Side Effect
Dental Problems
Side Effect
Dumping Syndrome
Side Effect
Dyspepsia (Indigestion)
Side Effect
Esophageal Dilation
Side Effect
Esophagitis
Side Effect
Eviscera­tion & Incisional Hernia
Complica­tion
Food Trapping
Side Effect
Gallstones
Side Effect
Gastric Fistula
Complica­tion
Gastritis
Side Effect
Gastroeso­phageal Reflux Disease (GERD)
Side Effect
Gastroin­testinal Leaks
Complica­tion
General Anesthesia Complica­tions
Complica­tion
Hair Loss
Side Effect
Heart Attack
Complica­tion
Hemorr­hage (Bleeding)
Complica­tion
Hiatal Hernia
Complica­tion
Hypogly­cemia
Complica­tion
Infection
Complica­tion
Intole­rance to Certain Foods
Side Effect
Kidney Stones
Side Effect
Marginal Ulcers
Side Effect
Nausea, Vomiting and/or Stomach Cramps
Side Effect
Organ Injury During Surgery
Complica­tion
Peritonitis
Complica­tion
Pneumonia
Complica­tion
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Complica­tion
Pouch Dila­tion
Complica­tion
Pulmonary Embolism
Complica­tion
Respira­tory Failure
Complica­tion
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Side Effect
Stenosis/­Stricture
Complica­tion
Stoma Obstruc­tion
Complica­tion
Stroke
Complica­tion
Thrombo­phlebitis
Complica­tion
Thrush (Yeast Infec­tion)
Side Effect
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Side Effect
Weight Regain
Side Effect
Wound Reopen­ing
Complica­tion
Wound Sepsis
Complica­tion
Issue
System
Abdominal Discomfort
Digestive
Abdominal hernia
Digestive
Abscess
integu­mentary (Skin)
Anemia
Circulatory
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Device
Blood Clots
Circulatory
Body Aches
Muscular
Body Feeling Changes
Central Nervous
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Digestive
Bowel Obstruction
Digestive
Deep Vein Thrombosis
Circulatory
Dehy­dration
Full body
Dental Problems
Skeletal
Dumping Syndrome
Digestive
Dyspepsia (Indigestion)
Digestive
Esophageal Dilation
Digestive
Esophagitis
Digestive
Eviscera­tion & Incisional Hernia
n/a
Food Trapping
Digestive
Gallstones
Digestive
Gastric Fistula
Digestive
Gastritis
Digestive
Gastroeso­phageal Reflux Disease (GERD)
Digestive
Gastroin­testinal Leaks
Digestive
General Anesthesia Complica­tions
Central Nervous
Hair Loss
integu­mentary (Skin)
Heart Attack
Circulatory
Hemorr­hage (Bleeding)
Circulatory
Hiatal Hernia
Digestive
Hypogly­cemia
Circulatory
Infection
Full body (Immune)
Intole­rance to Certain Foods
Digestive
Kidney Stones
Digestive
Marginal Ulcers
Digestive
Nausea, Vomiting and/or Stomach Cramps
Digestive
Organ Injury During Surgery
Full body
Peritonitis
n/a
Pneumonia
respiratory
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
device
Pouch Dila­tion
Digestive
Pulmonary Embolism
respiratory
Respira­tory Failure
respiratory
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
integu­mentary (Skin)
Stenosis/­Stricture
Digestive
Stoma Obstruc­tion
Digestive
Stroke
Central Nervous
Thrombo­phlebitis
Circulatory
Thrush (Yeast Infec­tion)
integu­mentary (Skin)
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Digestive
Weight Regain
Full body
Wound Reopen­ing
integu­mentary (Skin)
Wound Sepsis
integu­mentary (Skin)
Issue
Sleeve
Abdominal Discomfort
Abdominal hernia
Yes
Abscess
Yes
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Yes
Body Aches
Yes
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Yes
Bowel Obstruction
Yes
Deep Vein Thrombosis
Yes
Dehy­dration
Yes
Dental Problems
Dumping Syndrome
Dyspepsia (Indigestion)
Yes
Esophageal Dilation
Yes
Esophagitis
Yes
Eviscera­tion & Incisional Hernia
Yes
Food Trapping
Gallstones
Up to 1/3 of bariatric patients
Gastric Fistula
Yes
Gastritis
Yes
Gastroeso­phageal Reflux Disease (GERD)
About 20% after 1 year; About 3% after three years
Gastroin­testinal Leaks
About 2% of patients
General Anesthesia Complica­tions
Yes
Hair Loss
Yes
Heart Attack
Yes
Hemorr­hage (Bleeding)
About 1% of patients
Hiatal Hernia
Yes
Hypogly­cemia
Infection
Yes
Intole­rance to Certain Foods
Yes
Kidney Stones
Marginal Ulcers
Yes
Nausea, Vomiting and/or Stomach Cramps
Yes
Organ Injury During Surgery
Yes
Peritonitis
Yes
Pneumonia
Yes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Yes
Respira­tory Failure
Yes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Yes
Stenosis/­Stricture
About 1% of patients
Stoma Obstruc­tion
Stroke
Yes
Thrombo­phlebitis
Yes
Thrush (Yeast Infec­tion)
Yes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Yes
Weight Regain
Yes
Wound Reopen­ing
Yes
Wound Sepsis
Yes
Issue
Bypass
Abdominal Discomfort
Abdominal hernia
Yes
Abscess
Yes
Anemia
Yes
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Yes
Body Aches
Yes
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Yes
Bowel Obstruction
About 3% of patients
Deep Vein Thrombosis
Yes
Dehy­dration
Yes
Dental Problems
Yes
Dumping Syndrome
About 70% of patients
Dyspepsia (Indigestion)
Yes
Esophageal Dilation
Yes
Esophagitis
Yes
Eviscera­tion & Incisional Hernia
Yes
Food Trapping
Up to 2% of patients
Gallstones
Up to 1/3 of bariatric patients
Gastric Fistula
Yes
Gastritis
Yes
Gastroeso­phageal Reflux Disease (GERD)
Yes
Gastroin­testinal Leaks
About 2% of patients
General Anesthesia Complica­tions
Yes
Hair Loss
Yes
Heart Attack
Yes
Hemorr­hage (Bleeding)
About 2% of patients
Hiatal Hernia
Yes
Hypogly­cemia
Yes
Infection
About 3% of patients
Intole­rance to Certain Foods
Yes
Kidney Stones
Yes
Marginal Ulcers
Yes
Nausea, Vomiting and/or Stomach Cramps
Up to 70% of patients
Organ Injury During Surgery
Yes
Peritonitis
Yes
Pneumonia
Yes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Yes
Respira­tory Failure
Yes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Yes
Stenosis/­Stricture
About 5% of patients
Stoma Obstruc­tion
Stroke
Yes
Thrombo­phlebitis
Yes
Thrush (Yeast Infec­tion)
Yes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Yes
Weight Regain
Yes
Wound Reopen­ing
Yes
Wound Sepsis
Yes
Issue
Balloon
Abdominal Discomfort
Abdominal hernia
Abscess
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Body Aches
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Bowel Obstruction
Deep Vein Thrombosis
Dehy­dration
Dental Problems
Dumping Syndrome
Dyspepsia (Indigestion)
Esophageal Dilation
Esophagitis
Eviscera­tion & Incisional Hernia
Food Trapping
Gallstones
Gastric Fistula
Gastritis
Gastroeso­phageal Reflux Disease (GERD)
Gastroin­testinal Leaks
General Anesthesia Complica­tions
Hair Loss
Heart Attack
Hemorr­hage (Bleeding)
Hiatal Hernia
Hypogly­cemia
Infection
Intole­rance to Certain Foods
Yes
Kidney Stones
Marginal Ulcers
Yes
Nausea, Vomiting and/or Stomach Cramps
Yes
Organ Injury During Surgery
Yes
Peritonitis
Yes
Pneumonia
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Respira­tory Failure
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Stenosis/­Stricture
Stoma Obstruc­tion
Yes
Stroke
Thrombo­phlebitis
Thrush (Yeast Infec­tion)
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Weight Regain
Yes
Wound Reopen­ing
Wound Sepsis
Issue
Band
Abdominal Discomfort
Abdominal hernia
Yes
Abscess
Yes
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Up to 18% of patients
Blood Clots
Yes
Body Aches
Yes
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Yes
Bowel Obstruction
Yes
Deep Vein Thrombosis
Yes
Dehy­dration
Yes
Dental Problems
Dumping Syndrome
Dyspepsia (Indigestion)
Yes
Esophageal Dilation
About 14% of patients
Esophagitis
Yes
Eviscera­tion & Incisional Hernia
Yes
Food Trapping
Gallstones
Up to 1/3 of bariatric patients
Gastric Fistula
Yes
Gastritis
Yes
Gastroeso­phageal Reflux Disease (GERD)
Yes
Gastroin­testinal Leaks
General Anesthesia Complica­tions
Yes
Hair Loss
Yes
Heart Attack
Yes
Hemorr­hage (Bleeding)
Yes
Hiatal Hernia
Yes
Hypogly­cemia
Infection
Yes
Intole­rance to Certain Foods
Yes
Kidney Stones
Marginal Ulcers
Nausea, Vomiting and/or Stomach Cramps
Yes
Organ Injury During Surgery
Yes
Peritonitis
Pneumonia
Yes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
About 21% of patients
Pouch Dila­tion
Up to 17% of patients
Pulmonary Embolism
Yes
Respira­tory Failure
Yes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Yes
Stenosis/­Stricture
Stoma Obstruc­tion
Yes
Stroke
Yes
Thrombo­phlebitis
Yes
Thrush (Yeast Infec­tion)
Yes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Yes
Weight Regain
Yes
Wound Reopen­ing
Yes
Wound Sepsis
Yes
Issue
DS
Abdominal Discomfort
Abdominal hernia
Yes
Abscess
Yes
Anemia
Yes
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Yes
Blood Clots
Yes
Body Aches
Yes
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Yes
Bowel Obstruction
Yes
Deep Vein Thrombosis
Yes
Dehy­dration
Yes
Dental Problems
Yes
Dumping Syndrome
Dyspepsia (Indigestion)
Yes
Esophageal Dilation
Yes
Esophagitis
Yes
Eviscera­tion & Incisional Hernia
Yes
Food Trapping
Gallstones
Up to 1/3 of bariatric patients
Gastric Fistula
Yes
Gastritis
Yes
Gastroeso­phageal Reflux Disease (GERD)
Yes
Gastroin­testinal Leaks
Yes
General Anesthesia Complica­tions
Yes
Hair Loss
Yes
Heart Attack
Yes
Hemorr­hage (Bleeding)
Yes
Hiatal Hernia
Yes
Hypogly­cemia
Infection
Yes
Intole­rance to Certain Foods
Yes
Kidney Stones
Yes
Marginal Ulcers
Yes
Nausea, Vomiting and/or Stomach Cramps
Yes
Organ Injury During Surgery
Yes
Peritonitis
Yes
Pneumonia
Yes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Yes
Respira­tory Failure
Yes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Yes
Stenosis/­Stricture
Yes
Stoma Obstruc­tion
Stroke
Yes
Thrombo­phlebitis
Yes
Thrush (Yeast Infec­tion)
Yes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Yes
Weight Regain
Yes
Wound Reopen­ing
Yes
Wound Sepsis
Yes
Issue
vBloc
Abdominal Discomfort
Abdominal hernia
Abscess
Yes
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Yes
Body Aches
Yes
Body Feeling Changes
Yes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Bowel Obstruction
Deep Vein Thrombosis
Dehy­dration
Dental Problems
Dumping Syndrome
Dyspepsia (Indigestion)
Esophageal Dilation
Esophagitis
Eviscera­tion & Incisional Hernia
Yes
Food Trapping
Gallstones
Gastric Fistula
Yes
Gastritis
Gastroeso­phageal Reflux Disease (GERD)
Gastroin­testinal Leaks
General Anesthesia Complica­tions
Yes
Hair Loss
Heart Attack
Yes
Hemorr­hage (Bleeding)
Yes
Hiatal Hernia
Hypogly­cemia
Infection
Yes
Intole­rance to Certain Foods
Kidney Stones
Marginal Ulcers
Nausea, Vomiting and/or Stomach Cramps
Organ Injury During Surgery
Yes
Peritonitis
Pneumonia
Yes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Yes
Respira­tory Failure
Yes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Stenosis/­Stricture
Stoma Obstruc­tion
Stroke
Yes
Thrombo­phlebitis
Yes
Thrush (Yeast Infec­tion)
Yes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Weight Regain
Yes
Wound Reopen­ing
Yes
Wound Sepsis
Yes
Issue
Aspire­Assist
Abdominal Discomfort
Yes
Abdominal hernia
Abscess
Anemia
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)
Blood Clots
Body Aches
Body Feeling Changes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)
Yes
Bowel Obstruction
Deep Vein Thrombosis
Dehy­dration
Dental Problems
Dumping Syndrome
Dyspepsia (Indigestion)
Esophageal Dilation
Esophagitis
Eviscera­tion & Incisional Hernia
Food Trapping
Gallstones
Gastric Fistula
Gastritis
Gastroeso­phageal Reflux Disease (GERD)
Gastroin­testinal Leaks
General Anesthesia Complica­tions
Hair Loss
Heart Attack
Hemorr­hage (Bleeding)
Hiatal Hernia
Hypogly­cemia
Infection
Yes
Intole­rance to Certain Foods
Kidney Stones
Marginal Ulcers
Yes
Nausea, Vomiting and/or Stomach Cramps
Yes
Organ Injury During Surgery
Peritonitis
Pneumonia
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)
Pouch Dila­tion
Pulmonary Embolism
Respira­tory Failure
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)
Stenosis/­Stricture
Stoma Obstruc­tion
Yes
Stroke
Thrombo­phlebitis
Thrush (Yeast Infec­tion)
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tion
Weight Regain
Wound Reopen­ing
Wound Sepsis

For definitions of any issue in the chart, see our Bariatric Surgery Complications page.

Preventing Complications

In many cases, complications after any type of bariatric surgery arise because the patient didn’t follow their doctor’s instructions.

Behaviors that will dramatically reduce your risk of complications include:

  1. Pick a good surgeon
  2. Follow your surgical team’s advice to the letter
  3. Educate yourself
  4. Educate your family
  5. Lose as much weight as possible prior to surgery
  6. Eat a healthy diet in the months leading up to surgery
  7. Get tested for sleep apnea syndrome several weeks before surgery (and address the issue if it exists before moving forward)
  8. Plan for at least 2 weeks of recovery time
  9. Exercise as quickly as possible after surgery, starting slowly at first and working your way up
  10. Use compression stockings, pneumatic compression devices, and/or blood thinners after surgery (talk with your surgeon) to reduce risk of blood clots (for all procedures except gastric balloon)
  11. Have an effective support system of friends, family, and weight loss surgery support groups

Side Effects: Digestion & Sagging Skin

Digestion Issues

Digestion issues are possible after all procedures except vBloc Therapy. Most of the following issues are avoidable with the right diet and lifestyle changes:

 
 
Bowel Movement Problems
Bowel Movement Problems
Difficulty Swallowing
Difficulty Swallowing
Indigestion (Dyspepsia)
Indigestion (Dyspepsia)
Gallstones
Gallstones
Gastroeso­phageal Reflux Disease (GERD)
Gastroeso­phageal Reflux Disease (GERD)
Intolerance to certain foods
Intolerance to certain foods
Nausea and vomiting
Nausea and vomiting
Vitamin and/or mineral deficiency
Vitamin and/or mineral deficiency
 
Sleeve
Bowel Movement Problems
Yes
Difficulty Swallowing
Yes
Indigestion (Dyspepsia)
Yes
Gallstones
Yes
Gastroesophageal Reflux Disease (GERD)
Yes
Intolerance to certain foods
Yes
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
Unlikely
 
Bypass
Bowel Movement Problems
Yes
Difficulty Swallowing
Yes
Indigestion (Dyspepsia)
Yes
Gallstones
Yes
Gastroesophageal Reflux Disease (GERD)
Yes
Intolerance to certain foods
Yes
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
Yes
 
DS
Bowel Movement Problems
Yes
Difficulty Swallowing
Yes
Indigestion (Dyspepsia)
Yes
Gallstones
Yes
Gastroesophageal Reflux Disease (GERD)
Yes
Intolerance to certain foods
Yes
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
Yes
 
Band
Bowel Movement Problems
Yes
Difficulty Swallowing
No
Indigestion (Dyspepsia)
Yes
Gallstones
Yes
Gastroesophageal Reflux Disease (GERD)
Yes
Intolerance to certain foods
Yes
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
Unlikely
 
Balloon
Bowel Movement Problems
Yes
Difficulty Swallowing
Yes
Indigestion (Dyspepsia)
No
Gallstones
No
Gastroesophageal Reflux Disease (GERD)
No
Intolerance to certain foods
Yes
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
No
 
vBloc
Bowel Movement Problems
No
Difficulty Swallowing
No
Indigestion (Dyspepsia)
No
Gallstones
No
Gastroesophageal Reflux Disease (GERD)
No
Intolerance to certain foods
No
Nausea and vomiting
No
Vitamin and/or mineral deficiency
No
 
AspireAssist
Bowel Movement Problems
Yes
Difficulty Swallowing
No
Indigestion (Dyspepsia)
No
Gallstones
No
Gastroesophageal Reflux Disease (GERD)
No
Intolerance to certain foods
No
Nausea and vomiting
Yes
Vitamin and/or mineral deficiency
Possibly

Sagging Skin

Sagging skin is an issue for most patients who lose a lot of weight quickly, especially after the more involved procedures like gastric sleeve, gastric bypass, duodenal switch, and LAP-BAND®.

It is less likely after gastric balloon and vBloc therapy because patients tend to not lose as much weight after those procedures.

Weight Regain

Five to ten percent weight regain is common after most procedures, although it is much less likely after duodenal switch surgery due to that procedure’s unique combination of restriction and malabsorption.

Weight regain is usually the result of patients not following proper diet guidelines.

10Summary
  • Best procedure by category
  • Full side-by-side procedure comparison

Your individual situation will determine which type of bariatric surgery is best for you. Unfortunately, there is no “one size fits all” option. Following is a review of winners in each category:

Most Weight Loss

  • Winner: Duodenal Switch
  • Runners up: (Tie) Gastric Sleeve & Gastric Bypass

Best Health Improvement

  • Winner: Duodenal Switch
  • Runners up: (Tie) Gastric Sleeve & Gastric Bypass

Easiest to Qualify

  • Winner: No Clear Winner; Depends on Your Current BMI

Low-Cost Procedure (Without Insurance)

  • Winner: Gastric Balloon (but long-term costs likely higher than more expensive procedures)
  • Runner up: Lap Band (but long-term costs likely higher than more expensive procedures)

Low-Cost Procedure (With Insurance)

  • Winner: 4-Way Tie – Gastric Sleeve, Gastric Bypass, Duodenal Switch, & LAP-BAND®
  • Runner up: Gastric Balloon

Insurance Coverage

  • Winner: (4-Way Tie) Sleeve, Bypass, Band, & Duodenal Switch

Most Popular Procedure

  • Winner: Gastric Sleeve
  • Runner up: Gastric Bypass

Quickest Recovery

  • Winner: (Tie) vBloc Therapy, Gastric Balloon & AspireAssist
  • Runner up: LAP-BAND®

Best Post-Op Diet

  • Winner: Depends on Patient’s Goals; Easier Diet’s Usually Mean Less Weight Loss

Fewest Risks & Side Effects

  • Winner: vBloc Therapy
  • Runners up: (Tie) Gastric Balloon & Gastric Sleeve

Overall Winner for You Depends on Your Goals

If you’re still on the fence between two procedures, these pages will help you understand the differences:

12Help & Support
  • Patient experiences
  • Ask the expert

If you still have questions about the type of bariatric surgery, our experts are happy to answer them. We (and other patients) would also love to hear about your experiences with the balloon.

Please use the form below to share your experience or ask a question.

Close Help

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Questions From Other Visitors*

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

Bypass or Sleeve?*

I am scheduled for gastric bypass surgery in 8 days and am on day 7 of my liquid diet. I came into this wanting gastric bypass, because I do not…


Gastric Bypass Vs. Gastric Sleeve with GERD Symptoms Present*

I had my consult with a bariatric surgeon yesterday. I liked him a lot and he was helpful. Just one glitch - I am interested in the sleeve but I…


Is There a "Happy Middle-Ground" Weight Loss Procedure?*

I had the Gastric Balloon and just got it removed. I'm a little disappointed though because I didn't lose as much weight as I wanted to. I am 5'9 and…


Worried About Permanently Altering My Body*

Hi, I have been considering getting weight loss surgery for a while now, but I've been straddling the fence on the decision. I had a friend who underwent the gastric…


13Find a Top Gastric Sleeve Surgeon
  • Ask for a free insurance check or cost quote
  • Attend a free seminar or webinar
  • Schedule a phone or in-person consultation (both often free)

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Advertisement

References for Types of Bariatric Surgery: Full Comparison

  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

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. 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