I will briefly describe the essential points of difference between the 3 most commonly offered bariatric surgeries. When deciding which surgery you will have, you have to decide which positive and negative points about each operation are most relevant or important to you. The decision should be made with thorough assessment and discussion with your surgeon and care team.
- it is reversible
- the stomach is left intact
- has the lowest serious morbidity and mortality rates of all three
- can achieve up to 50-60% excess weight loss if follow up and band fills
performed appropriately and patient follows ‘post-band’ dietary advice
- in situations where you may need your dietary intake to increase, it is
possible to temporarily reverse the restriction on the diet by deflating the
band through the port
- generally does not achieve as much excess weight loss as the gastric
- insertion of a prosthesis (silicone), and any prosthesis or foreign body
has the potential for developing infection
- patients need follow up forever and needs frequent appointment during
which the fluid in the band needs to be changed to optimise weight loss
- problems may occur any time in future which may need reoperation or
even removal of the band including 1. slippage of band, 2. erosion of
band into stomach, 3. dilation (stretching) of small pouch or oesophagus
above the band, 4. port or tubing problems such as flipping over of port or
hole and leakage of tubing.
- If the band needs to be removed for some reason, then most of the
weight lost is often regained.
- there are no anastomoses (joins) required to be performed or to heal in
- may be possible in severely obese patients if bypass is not technically
feasible due to massive intra-abdominal fat
- These patients may potentially not need to be followed up as frequently
as the gastric band or gastric bypass patients
- There is a lack of long-term data of this operation as it is newer than the
gastric bypass and gastric band
- There is some concern that the tube of stomach can stretch over time and
cause less restriction to the diet
- There is a long staple line where a large part of the stomach is removed,
and this staple line has the potential risk of leaking, which can be a very
- It probably achieves the greatest excess weight loss at about 60-70%
(hence it tends to be the operation recommended for the massively
obese patients with BMI >50).
- It has the highest peri-operative morbidity and mortality rates (although
fairly low, these are is still higher than the gastric band)
- It has the potential risks of leakage from the staple lines or the (two) joins
or narrowing of one join in particular, there are risk of bowel twisting
around each other, higher risks potentially of malabsorption of important
nutrients and vitamins. Some of these surgical risks can be very serious
or even fatal
- It is essentially not reversible
- Still need relatively frequent follow up by your surgeon and/or dietician to
make sure you are not developing any serious malabsorption syndromes
All surgeries have the risk of failure of loss of weight or risk of regaining lost weight for one reason or another and all surgeries require patient compliance in following the recommended dietary changes. They all also carry the increased risks of surgery that occur with obese patients compared with non-obese.
I hope this helps you to understand what needs to be considered when making your decision but again I stress that you should have a thorough discussion with your surgeon and care team when making this decision.
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