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

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

Reviewed by:  

John Rabkin, MD

Last Updated:  

10/20/2017

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

types of bariatric surgery

WEIGHT LOSS PROCEDURE OVERVIEW

Click a procedure to learn more.
GASTRIC BALLOONPROCEDURE TYPE: RESTRICTIVE

Inflated balloon(s) in the stomach cause you to feel full sooner while eating.

Gastric SleevePROCEDURE TYPE: RESTRICTIVE

Reduced stomach size makes you feel less hungry & full sooner while eating.

Lap BandPROCEDURE TYPE: RESTRICTIVE

Band wraps around top of stomach, creating a small stomach "pouch" that causes you to feel full sooner while eating.

vBlocPROCEDURE TYPE: VAGAL NERVE BLOCKING

Implanted device prevents hunger signals from reaching the brain, making you feel full between meals and full sooner while eating.

Gastric BypassPROCEDURE TYPE: MALABSOPTIVE

Reduced stomach size makes you feel less hungry & full sooner while eating, and rearranged intestines causes your body to absorb fewer minerals.

Duodenal SwitchPROCEDURE TYPE: MALABSOPTIVE

Reduced stomach size makes you feel less hungry & full sooner while eating, and rearranged intestines causes your body to absorb fewer calories & minerals.

Aspire AssistPROCEDURE TYPE: ASPIRATION

You attach a device to an abdominal port after each meal and drain about 1/3 of stomach contents, causing your body to absorb fewer calories & minerals.

Click to Collapse SectionClick to Learn More

Most Popular Procedure

  • Winner: Gastric Sleeve

  • Runner Up: Gastric Bypass

Procedure Fundamentals: Restriction, Malabsorption, Vagal Nerve Stimulation, & Aspiration

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-approved 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

Types of Bariatric Surgery

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

gastric balloon

3 Gastric Balloon Types

Orbera: 1 balloon

Reshape: 2 connected balloons

Obalon: 3 separate balloons inserted over time

The gastric balloon procedure is performed differently depending on which balloon type you choose:

Orbera & ReShape

The Orbera and ReShape gastric balloon procedures usually takes no more than a half hour to perform (compared to about 2 hours for gastric sleeve), and most patients are out of the hospital on the same day.

Once you are set up in the treatment room, following are the steps:

  1. Your throat will be numbed with a special spray. The numbing sensation may feel strange, but it will help your throat tolerate the instruments used in the procedure. If you wish, you can also ask for an injection to make you feel sleepy, but these options will be discussed with you beforehand.
  2. After you are comfortable, the nurse will insert a plastic mouth guard between your teeth to keep your mouth open for the scope.
  3. The scope will be passed through your mouth and into your stomach. This will not be painful, and you will be able to breath without worry. The doctor may also need to pass some air down the scope to have a clear view. This too can be a strange feeling, and it may make you want to belch.
  4. The scope will be removed.
  5. The deflated balloon will be passed into your stomach and inflated with either air or saline solution.
  6. The scope will be passed into your stomach one final time to double check that the balloon is in the right position and properly inflated.

Obalon

The Obalon balloon procedure is the same as Orbera and ReShape above, except:

  1. The balloon is swallowed in pill form (3 balloon pills swallowed one at a time over 3 months) rather than being inserted with an endoscope.
  2. A scope is not used until the Obalon balloons are removed.

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

ENTER YOUR STATS FOR YOUR WEIGHT LOSS PROJECTIONS

Enter your height & weight, then click the button:

Enter your height & weight, then click the button:

Click to Collapse SectionClick to Learn More

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

Types of Bariatric Surgery

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

 3 Months6 Months1 Year2 Years3 Years5 Years8 Years11 Years
Gastric Sleeve30%50%70%65%60%55%56%62.5%
Gastric Bypass30%50%65%60%60%60%no data yetno data yet
Gastric Balloon15%30%varies (balloon remov­ed after 6 mo)varies (balloon remov­ed after 6 mo)varies (balloon remov­ed after 6 mo)varies (balloon remov­ed after 6 mo)no data yetno data yet
Duodenal Switch30%45%65%70%70%70%no data yetno data yet
LAP-BAND®20%30%40%55%55%55%no data yetno data yet
vBloc Therapy10%20%25%25%25%25%no data yetno data yet
Aspire Assist20%25%30%no data yetno data yetno data yetno data yetno 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)

Advertisement

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

Types of Bariatric Surgery

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-morbidityGastric Sleeve % Improved /ResolvedBypass % Improved /ResolvedDS % Improved /ResolvedBand % Improved /ResolvedGastric Balloon % Improved /ResolvedAsipreAssist % Improved/ ResolvedvBloc % Improved /Resolved
Dyslipidemia hyperchole­sterolemia64%63%99%70%10% 
Diabetes55%83%92%60%33%Possible improve­mentModerate
Hyperli­pidemia (high levels of fat in the blood, high cholesterol)35%73%99%23%34%Possible improve­ment
High Blood Pressure (hyper­tension)68%69%83%43%45%Possible improve­ment
Joint/Bone Disease (osteoar­thropathy)46%43%43%81%48% 
DepressionMostMostMost57%  
Migraines40%57%MostSome  
Pseudo­tumor cerebrin/a96%Most  
Cardiova­scular Disease100%79%86%73%  Moderate
Venous Stasis Disease95%95%  
Gastroeso­phageal Reflux Disease (GERD)50%80%49%87%  
Non-Alcoholic Fatty Liver Diseasen/a90%99%Most  
Mortality Reduction/ Life Expectancy (5 year mortality)89%89%89%89%  
Quality of Life Improve­ments93%95%95%Most  
Metabolic Syndrome62%80%99%78%  
Polycystic Ovarian SyndromeMostMost48%Most  
PregnancyMostMostMost  
Asthma90%80%90%82%  
Obstructive Sleep Apnea62%98%99%85%  
Stress Urinary Incontinence90%88%82%  

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

Types of Bariatric Surgery

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

CHECK MY
INSURANCE TOOL
1

Choose your plan, state, and insurance company below.

Can’t find your insurance company/plan or have updated info? Click here to contact us.

This tool provides estimates only. Please contact your insurance company to verify your actual out of pocket costs.

Click to Collapse SectionClick to Learn More

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 Range: $8,000 to $27,000, depending on procedure
  • Loan Payment: $178 to $445/month, depending on procedure
  • 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

WEIGHT LOSS PROCEDURE OVERVIEW

Click a procedure to learn more.
Click to Collapse SectionClick to Learn More

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

Types of Bariatric Surgery

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

Types of Bariatric Surgery

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:

 Sleeve, Bypass, DS, BandvBlocBalloonAspireAssist
Practice your post-surgery diet2+ Weeks Before2+ Weeks Before
High protein, low sugar, low carbs2+ Weeks Before
Stop or change some medications1 Week Before
Clear liquids only2 Days Before
Nothing to eat or drinkMidnight Before SurgeryMidnight Before Until After SurgeryMidnight Before Until After Balloon PlacementMidnight Before Until After Tube Placement
Sugar-free clear liquids onlyIn Hospital to 7 Days After Surgery (Varies by Surgeon)Until After SurgeryUntil After Balloon PlacementIn Hospital to 7 Days After Surgery (Varies by Surgeon)
Add thicker drinks & smooth foodsDay 1 to Week 2 After Surgery (Varies by Surgeon)Day 2 through 7
Slowly test pureed foods & soft solid foodsDay 2 to Week 3 After Surgery (Varies by Surgeon)15%Day 6 through 14Day 1 to Week 2 After Surgery (Varies by Surgeon)
Slowly test solid foodsDay 3 to Weeks 4+ After Surgery (Varies by Surgeon)Weeks 3+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

Types of Bariatric Surgery

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

IssueComplica­tion or Side EffectSystemSleeveBypassBalloonBandDSvBlocAspire­Assist
Abdominal DiscomfortSide EffectDigestiveYes
Abdominal herniaComplicationDigestiveYesYesYesYes
AbscessComplicationintegu­mentary (Skin)YesYesYesYesYes
AnemiaSide EffectCirculatoryYesYes
Band Problems (band erosion, band infection, band intolerance, band leak, band slippage)ComplicationDeviceUp to 18% of patientsYes
Blood ClotsComplicationCirculatoryYesYesYesYesYes
Body AchesSide EffectMuscularYesYesYesYesYes
Body Feeling ChangesSide EffectCentral NervousYesYesYesYesYesYes
Bowel Function Changes (diarrhea, constipation, foul-smelling bowel movements and flatulence, difficulty swallowing, gurgling noises)Side EffectDigestiveYesYesYesYesYes
Bowel ObstructionComplicationDigestiveYesAbout 3% of patientsYesYes
Deep Vein ThrombosisComplicationCirculatoryYesYesYesYes
DehydrationSide EffectFull bodyYesYesYesYes
Dental ProblemsSide EffectSkeletalYesYes
Dumping SyndromeSide EffectDigestiveYesYesYesYes
Dyspepsia (Indigestion)Side EffectDigestiveAbout 70% of patients
Esophageal DilationSide EffectDigestiveYesYesAbout 14% of patientsYes
EsophagitisSide EffectDigestiveYesYesYesYes
Eviscera­tion & Incisional HerniaComplicationYesn/aYesYesYesYesYes
Food TrappingSide EffectDigestiveUp to 2% of patients
GallstonesSide EffectDigestiveUp to 1/3 of bariatric patientsUp to 1/3 of bariatric patientsUp to 1/3 of bariatric patientsUp to 1/3 of bariatric patients
Gastric FistulaComplicationDigestiveYesYesYesYesYes
GastritisSide EffectDigestiveYesYesYesYes
Gastroeso­phageal Reflux Disease (GERD)Side EffectDigestiveAbout 20% after 1 year; About 3% after three yearsYesYesYes
Gastrointestinal LeaksComplicationDigestiveAbout 2% of patientsAbout 2% of patientsYes
General Anesthesia Complica­tionsComplicationCentral NervousYesYesYesYesYes
Hair LossSide Effectintegu­mentary (Skin)YesYesYesYes
Heart AttackComplicationCirculatoryYesYesYesYesYes
Hemorrhage (Bleeding)ComplicationCirculatoryAbout 1% of patientsAbout 2% of patientsYesYesYes
Hiatal HerniaComplicationDigestiveYesYesYesYes
Hypogly­cemiaComplicationCirculatoryYes
InfectionComplicationFull body (Immune)YesAbout 3% of patientsYesYesYesYes
Intole­rance to Certain FoodsSide EffectDigestiveYesYesYesYesYes
Kidney StonesSide EffectDigestiveYesYes
Marginal UlcersSide EffectDigestiveYesYesYesYesYes
Nausea, Vomiting and/or Stomach CrampsSide EffectDigestiveYesUp to 70% of patientsYesYesYesYes
Organ Injury During SurgeryComplicationFull bodyYesYesYesYesYesYes
PeritonitisComplicationn/aYesYesYesYes
PneumoniaComplicationrespiratoryYesYesYesYesYes
Port Problems (port flip/ inver­sion or dislodge­ment, port leak, port infec­tion, port disloca­tion)ComplicationdeviceAbout 21% of patients
Pouch DilationComplicationDigestiveUp to 17% of patients
Pulmonary EmbolismComplicationrespiratoryYesYesYesYesYes
Respiratory FailureComplicationrespiratoryYesYesYesYesYes
Skin Changes (e.g. acne, dry skin, sagging skin, etc.)Side Effectintegu­mentary (Skin)YesYesYesYes
Stenosis/­StrictureComplica­tionDigestiveAbout 1% of patientsAbout 5% of patientsYes
Stoma Obstruc­tionComplica­tionDigestiveYesYesYes
StrokeComplica­tionCentral NervousYesYesYesYesYes
Thrombo­phlebitisComplica­tionCirculatoryYesYesYesYesYes
Thrush (Yeast Infec­tion)Side Effectintegu­mentary (Skin)YesYesYesYesYes
Vitamin & Mineral Deficiency / Malnutri­tion / Malabsorp­tionSide EffectDigestiveYesYesYesYes
Weight RegainSide EffectFull bodyYesYesYesYesYesYes
Wound Reopen­ingComplica­tionintegu­mentary (Skin)YesYesYesYesYes
Wound SepsisComplica­tionintegu­mentary (Skin)YesYesYesYesYes

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:

 SleeveBypassDSBandBalloonvBlocAspireAssist
Bowel Movement ProblemsYesYesYesYesYesNoYes
Difficulty SwallowingYesYesYesNoYesNoNo
Indigestion (Dyspepsia)YesYesYesYesNoNoNo
GallstonesYesYesYesYesNoNoNo
Gastroeso­phageal Reflux Disease (GERD)YesYesYesYesNoNoNo
Intolerance to certain foodsYesYesYesYesYesNoNo
Nausea and vomitingYesYesYesYesYesNoYes
Vitamin and/or mineral deficiencyUnlikelyYesYesUnlikelyNoNoPossibly

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

Types of Bariatric Surgery

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

Types of Bariatric Surgery

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

Entering your question or experiences is easy to do. Just type!… Your comments and questions will appear on a Web page exactly the way you enter it here. You can wrap a word in square brackets to make it appear bold. For example [my story] would show as my story on the Web page containing your story. TIP: Since most people scan Web pages, include your best thoughts in your first paragraph.

Upload 1-4 Pictures or Graphics (optional) [ ? ]

Close Help

Do you have some pictures or graphics to add? Great! Click the button and find the first one on your computer. Select it and click on the button to choose it. Then click on the link if you want to upload up to 3 more images.

 

Click here to upload more images (optional)

Author Information (optional)


To receive credit as the author, enter your information below.

(first or full name)

(e.g., City, State, Country)

Submit Your Contribution

submission guidelines.

Submit Your Question or Contribution



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)

SEARCH BY LOCATION

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