Here is a list of all the different WLS that I am aware of. They all have thier pros and cons and if a patient doesn't listen to their doctor I don't care what surgery one has they will end up back at square one or pretty close to it.
Types of Weight Loss Surgeries
There are several types of restrictive and combined operations that lead to rapid weight loss. Each one has its own benefits and risks.
Restrictive Weight Loss Surgeries
Purely restrictive operations only limit food intake and do not interfere with the normal digestive process. To perform the operation, doctors create a small pouch at the top of the stomach where food enters from the esophagus. At first, the pouch holds about 1 ounce of food and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ¾ inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness, thus resulting in rapid weight loss in most patients.
After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ¾ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and well chewed. Patients who undergo restrictive procedures generally are not able to eat as much as those who have combined operations.
1. Adjustable Gastric Banding (also known as the LAP-BAND) In this procedure, a hollow band made of silicone rubber is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is then inflated with a salt solution through a tube that connects the band to an access port placed under the skin. It can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution.
Advantages of this weight loss surgery:
Simple and relatively safe
Short recovery period
Major complication rate is low
No removal of any part of the stomach or intestines
No altering of the natural anatomy
Very short recovery periods
Disadvantages of this weight loss surgery:
About 5% failure rate because of
Balloon leakage
Band erosion/migration
Deep infection
Identifying patients who will not eat through the operation is difficult
For additional support and information about this surgery visit the Lap-Band? Forum
2.Vertical Sleeve Gastrectomy (also called vertical Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and even Vertical Gastroplasty) is performed by approximately 15 surgeons worldwide. The originally procedure, conceived by Dr. D Johnston in England, was called The Magenstrasse and Mill Operation. It generates rapid weight loss by restricting the amount of food that can be eaten (removal of stomach or vertical gastrectomy) without any bypass of the intestines or malabsorption. The stomach pouch is usually made smaller than the pouch used in the Duodenal Switch.
Advantages of this weight loss surgery:
Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts.
Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
No dumping syndrome because the pylorus is preserved.
Minimizes the chance of an ulcer occurring.
By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.
Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2).
Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
Can be done laparoscopically in patients weighing more than 500 pounds
Disadvantages of this weight loss surgery:
Potential for inadequate weight loss or weight regain. While true for all procedures, it is theoretically more possible with procedures without intestinal bypass.
Higher BMI patients will may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons.
Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss.
This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
Considered investigational by some surgeons and insurance companies.
For additional support and information about this surgery visit the Vertical Sleeve Gastrectomy Forum
3. Vertical Banded Gastroplasty (VBG) (see figure 3) VBG uses both a band and staples to create a small stomach pouch, resulting in quick weight loss. Once the most common restrictive operation, VBG is not often used today.
Advantages of this weight loss surgery:
completely reversible
body anatomy is left intact
no dumping syndrome
no nutritional deficiencies
Disadvantages of this weight loss surgery:
needs strict patient compliance to diet
no malabsorption
vomiting if food is not properly chewed or if food is eaten too quickly
For additional support and information about this surgery visit the Vertical Banding Forum
Advantages/Disadvantages Overview
Advantages: Restrictive weight loss surgeries are easier to perform and are generally safer than malabsorptive operations. AGB is usually done via laparoscopy, which uses smaller incisions, creates less tissue damage, and involves shorter operating time and hospital stays than open procedures. Restrictive weight loss surgeries can be reversed if necessary, and result in few nutritional deficiencies.
Disadvantages: Patients who undergo restrictive weight loss surgeries generally lose less weight than patients who have malabsorptive operations, and are less likely to maintain weight loss over the long term. Patients generally lose about half of their excess body weight in the first year after restrictive procedures. However, in the first 3 to 5 years after VBG patients may regain some of the weight they lost. By 10 years, as few as 20 percent of patients have kept the weight off. (Although there is less information about long-term results with AGB, there is some evidence that weight loss results are better than with VBG.) Some patients regain weight by eating high-calorie soft foods that easily pass through the opening to the stomach. Others are unable to change their eating habits and do not lose much weight to begin with. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity.
Risks: One of the most common risks of restrictive operations is vomiting, which occurs when the patient eats too much or the narrow passage into the larger part of the stomach is blocked. Another is slippage or wearing away of the band. A common risk of AGB is breaks in the tubing between the band and the access port. This can cause the salt solution to leak, requiring another operation to repair. Some patients experience infections and bleeding, but this is much less common than other risks. Between 15 and 20 percent of VBG patients may have to undergo a second operation for a problem related to the procedure. Although restrictive operations are the safest of the bariatric procedures, they still carry risk in less than 1 percent of all cases, complications can result in death.
Because combined weight loss surgeries result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.
Combined Restrictive/Malabsorptive Weight Loss Surgeries
Combined operations are the most common bariatric procedures. They restrict both food intake and the amount of calories and nutrients the body absorbs.
1. Roux-en-Y Gastric Bypass (RGB)This operation is the most common and successful combined weight loss surgery in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Rarely, a cholecystectomy (gall bladder removal) is performed to avoid the gallstones that may result from rapid weight loss. More commonly, patients take medication after the operation to dissolve gallstones.
Advantages of this weight loss surgery:
greatly controls food intake, leading to rapid weight loss
dumping syndrome dumping conditions to control intake of sweets
reversible in an emergency though this procedure should be thought of as a permanent
Disadvantages of this weight loss surgery:
staple line failure
ulcers
narrowing/blockage of the stoma
vomiting if food is not properly chewed or if food is eaten to quickly
weight re-gain is known to happen if dietary changes are not followed long term
Note (figure 4): This is the RNY without the stomach being transected or divided. This type RNY is not widely done anymore. Most surgeon perform the RNY with the stomach divided with no staple line. Transected means: stomach is completely separated from the new stomach
2. Duodenal Switch (also called vertical gastrectomy with duodenal switch, biliopancreatic diversion with duodenal switch, DS or BPD-DS) is performed by approximately 50 surgeons worldwide. It generates weight loss by restricting the amount of food that can be eaten (partial gastrectomy (i.e., partial removal of the stomach along the outer curvature see diagram) and by limiting the amount of food (specifically fat) that is absorbed into the body (intestinal bypass or duodenal switch). This weight loss surgery is more controversial because it has a significant component of malabsorption (bypass of the intestinal tract), which seems to augment and help maintain long-term weight loss. Of the procedures currently performed for the treatment of obesity, it has some powerful and effective components. Due to concerns of possible long-term effects of malabsorption and the technical difficulty involved with this type of weight loss surgery, many surgeons don't perform it.
Advantages of this weight loss surgery:
More normal stomach allows for better eating quality, drink with meals
No dumping syndrome because the pylorus is preserved
Minimizes ulcer risk
Very effective for high BMI patients (BMI>55 kg/m2), but can be done on lower BMI just as effectively
The intestinal bypass is partially reversible for those having malabsorptive complications
Laparoscopic approach is offered by some surgeons
Disadvantages of this weight loss surgery:
Chance of chronic diarrhea, possibly more foul smelling stools and gas. This can be due to dieting intake, but for the most part controlled.
Malabsorption can lead to anemia, protein deficiency and metabolic bone disease in up to 5 percent of patients
Carbohydrates can be well absorbed and if eaten in significant quantities lead to inadequate weight loss
This procedure is the most complex surgical weight loss procedure. As with any of the surgeries listed complications can occur in high risk patients.(heart failure, sleep apnea)
For additional support and information on this surgery visit the Duodenal Switch Forum
To locate a Duodenal Switch surgeon in your area click here
3. Biliopancreatic Diversion (BPD) In this more complicated combined weight loss surgery, the lower portion of the stomach is removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure leads to weight loss, it is used less often than other types of operations because of the high risk for nutritional deficiencies. This surgery is not commonly done anymore.
Advantages of this weight loss surgery:
significant malabsorptive component
better chance of sustained weight loss
ability to eat larger quantities of food and still loose weight
Disadvantages of this weight loss surgery:
greater chance of chronic diarrhea, stomal ulcers, more foul smelling stools and flatus
higher risk of nutritional deficiencies
higher chance of micro-nutrient deficiencies such as vitamins and calcium
Advantages/Disadvantages Overview
Advantages: Most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more. With BPD/DS, most studies report an average weight loss of 75 to 80 percent of excess weight. Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.
Disadvantages: Combined procedures are more difficult to perform than the restrictive procedures. Such weight loss surgeries are also more likely to result in long-term nutritional deficiencies. This is because these weight loss surgeries causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed.
Menstruating women may develop anemia because not enough vitamin B12 and iron are absorbed. Decreased absorption of calcium may also bring on osteoporosis and related bone diseases. Patients must take nutritional supplements that usually prevent these deficiencies. Patients who have the biliopancreatic diversion procedure must also take fat-soluble (dissolved by fat) vitamins A, D, E, and K supplements.
RGB and BPD operations may also cause dumping syndrome, an unpleasant reaction that can occur after a meal high in simple carbohydrates, which contain sugars that are rapidly absorbed by the body. Stomach contents move too quickly through the small intestine, causing symptoms such as nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it reduces the likelihood of dumping syndrome.
Risks with these weight loss surgery procedurs:In addition to risks associated with restrictive procedures such as infection, combined operations are more likely to lead to complications. Combined operations carry a greater risk than restrictive operations for abdominal hernias (up to 28 percent), which require a follow-up operation to correct. The risk of hernia, however, is lower (about 3 percent) when laparoscopic techniques are used.
As with any surgery, there can be complications. This list can include:
Deep vein thrombophlebitis
Non-fatal pulmonary embolus
Pneumonia
Acute respiratory distress syndrome
Splenectomy
Gastric leak and fistula
Duodenal leak
Distal Roux-en-Y leak
Postoperative bleeding
Duodenal stomal obstruction
Small bowel obstruction
Death
Laparoscopic Bariatric Surgery
In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. Patients who are super-obese (more than 350 pounds) or have had previous abdominal operations may not be good candidates for laparoscopy, however. Adjustable gastric banding is routinely performed via laparoscopy.
This technique is often used for Roux-en-Y gastric bypass, and although less common, biliopancreatic diversion can also be performed laparoscopically. The small incisions result in less blood loss, shorter hospitalization, a faster recovery, and fewer complications than open operations. However, combined laparoscopic procedures are more difficult to perform than open procedures and can create serious problems if done incorrectly.
