Comparative table of procedure types

Surgery type

RESTRICTIVE + MALABSORPTIVE

RESTRICTIVE + ENDOCRINE

ONLY RESTRICTIVE

Name

GASTRIC BYPASS

GASTRIC TUBE OR “SLEEVE GASTRECTOMY”

ADJUSTABLE GASTRIC BANDING

Anatomic description

A small stomach pouch is created (20-30cc) and connected to the small intestine, dividing food and gastric juices over 100-150cm.

A gastric tube of
60-100cc. is created

The gastric band is an adjustable silicone prosthetic device that is placed around the top portion of the stomach.
A small stomach pouch of 15-20cc. is created

Image

How does it work:

Food intake is reduced.
Controlled malabsorption.
Small diarrheas if excess of sugars or fats.

Food intake is reduced.
NO malabsorption
/diarrheas.
Natural stomach function is maintained.

Food intake is reduced.
Delays stomach emptying
Needs permanent prosthetic device for life

Weight loss:

70-80% excess weight.
Most proven and tested operation.

65%-70% excess weight.
Longest experience is 6 years.

50% excess weight.
Requires the most effort by the patient.

Long term dietetic habits modification

Initial intake is about 800 cal/day over 18 months.
After a while 1000-1200 calories/day.
Most patients must stay away from sweets and fatty foods to avoid  "Dumping”
Vitamins are needed, Fe, Ca, to compensate for reduced absorption of essential nutrients.

Initial intake is about
600-800 cal/day over 12 months.
After a while 1000-1200 calories/day
No dumping, no
diarrhea
No vitamins or supplements needed for life

Initial intake is about 800 cal/day and after a while 1000-1200 calories/day
When eating too fast, certain foods (rice, bread, dried meats, popcorn…) can cause pain and vomiting.
If eating habits are not modified, the weight loss can be regained.

Potential Problems

Dumping syndrome
Stenosis or anastomotic ulcer
Intestinal Obstruction.
Nutritional deficiencies :Iron, Vitamin B12, Folic Acid
Diarrhea

Reflux and regurgitation/ vomiting.
Stenosis
Regaining weight loss
Additional procedure might be needed

Too little weight loss
Band Slippage 3%
Stomach erosion 1%
Infection 1%
Access port problems 2%
Band and esophagus malfunctioning

Procedure duration

3-4 hours

2 hours

1.5 hours

Off-work timing

1 week
(low physical activity or sedentary work )

1 week
(low physical activity or sedentary work )

2-3 days
(low physical activity or sedentary work )

Our recommendation

Most efficient treatment for BMI of 45-55, when patient can’t control sweets and snacks.
However, this procedure might have more long term complications and nutritional supplements are needed for life.

Very safe. It must be used with extremely obese patients
(BMI>55).
Appropriate for patients with BMI between 35-45 because of the low operational risk.
 Must control sweets and snacks.

Requires more effort by the patient.
Appropriate for patients who want to participate in a program to change eating habits, with dietetic restrictions and physical exercise for life!!.