The Journey...
Researching weight loss methods
Researching surgery
The benefits
Risks and side effects
►The surgery types◄
Still undecided
Mapping out your plan of attack
Getting authorization
Preparing for initial consult
Waiting for insurer approval
Insurance troubles
Surgery date scheduled
Insurance references

The surgery types

There is so much information about all the different kinds of weight-loss surgery, it is hard to be able to tell which one is best. The answer? There is none that one can call the best. Because we are all different, the patient must weigh the pros and cons for their particular situation. Just because one surgery may work for one person, it may not be the best option for another.

Below, you will find a chart listing some of the advantages and disadvantages of some of the more commonly performed bariatric surgery procedures. The most important thing you can do for yourself is to research, in depth, all of the procedures. Then you should discuss them with your surgeon before making a final decision.

The Sapala-Wood Micropouch®
Roux-en-Y Gastric Bypass Operation

The Sapala-Wood Micropouch® Roux-en-Y Gastric Bypass Operation In the Sapala-Wood Micropouch® operation the very top of the stomach is completely divided. It is not stapled. This division results in the creation of a small “micropouch” completely separate from the lower part of the stomach. This Sapala-Wood Micropouch® is about the size of a grape (1-2 cc).

The small intestine is divided into two ends. One end travels upward to be connected to the Sapala-Wood Micropouch®.The other end is attached downward to the side of the distal small intestine to complete the circuit. Food travels down the esophagus, through the Sapala-Wood Micropouch®, to the intestine It bypasses the stomach. The bottom of the stomach no longer receives any food or liquids. But the stomach will still function because its nerve and blood supply are intact.
Click here to see a video on the Micropouch® procedure
Advantages Disadvantages
  • greatly controls food intake
  • dumping syndrome — dumping conditions to control intake of sweets
  • less susceptible to ulcers
  • limits the total number of calories that can be absorbed by the gastrointestinal or GI tract
  • narrowing/blockage of the stoma
  • vomiting if food is not properly chewed or if food is eaten to quickly


Adjustable Gastric Banding (AGB)

Adjustable Gastric Banding In this procedure, commonly known as the LapBand®, a silicone elastomer band is placed around the upper part of the stomach to create a small stomach pouch which can hold only a small amount of food. The lower, larger part of the stomach is below the band. These two parts are connected by a small outlet created by the band. Food will pass through the outlet (“stoma” in medical terms) from the upper stomach pouch to the lower part more slowly, and one will feel full longer. The diameter of the band outlet is adjustable to meet individual needs, which can change as one loses weight.

On the inner lining of the band there is a longitudinal balloon (like a bicycle tire). The band is left empty at time of surgery but is thereafter gradually filled with fluid by injection through the subcutaneous (just under the skin) port. It is thus possible to vary the opening in the stomach after surgery. This can be done in the surgeon's office.
Advantages Disadvantages
  • Simple and relatively safe
  • Short recovery period
  • Major complication rate is low
  • No opening or removal of any part of the stomach or intestines
  • No altering of the natural anatomy
  • Very short recovery periods
  • About 5% failure rate because of:
    • Balloon leakage
    • band erosion/migration
    • deep infection
  • Identifying patients who will not “eat through” the operation is difficult


Vertical Banded Gastroplasty (VBG)

Vertical Banded Gastroplasty This, along with the RNY, is one of the two major types of operations recognized by the NIH for the treatment of clinically severe obesity. It is a purely restrictive procedure with no malabsorptive effect. The goal of this procedure is to severely restrict the patient's capacity to eat certain foods.
Advantages Disadvantages
  • completely reversible
  • body anatomy is left intact
  • no dumping syndrome
  • no nutritional deficiencies
  • needs strict patient compliance to diet
  • no malabsorption
  • vomiting if food is not properly chewed or if food is eaten too quickly


Roux-en-Y (RNY)

Roux-en-Y This operation is the most common gastric bypass procedure. With this procedure a portion of the stomach is sectioned off, creating a small pouch for reduced food intake. The pouch will usually hold about one ounce of food or less, which causes the feeling of fullness after just a few bites. The size of the pouch varies with different doctors.
Advantages Disadvantages
  • greatly controls food intake
  • dumping syndrome — dumping conditions to control intake of sweets
  • reversible in an emergency — though this procedure should be thought of as a permanent
  • staple line failure
  • ulcers
  • narrowing/blockage of the stoma
  • vomiting if food is not properly chewed or if food is eaten to quickly


Biliopancreatic Diversion (Scopinaro procedure) (BPD)

Biliopancreatic Diversion This procedure is less food restrictive than the RNY. The stomach capacity is 4-5 ounces compared with RNY of around an ounce. There is a significant malabsorptive component which acts to maintain weight loss long term. The patient must be closely monitored to guard against severe nutritional deficiencies.
Advantages Disadvantages
  • significant malabsorptive component
  • better chance of sustained weight loss
  • ability to eat larger quantities of food and still loose weight
  • greater chance of chronic diarrhea, stomal ulcers, more foul smelling stools and flatus
  • higher risk of nutritional deficiencies
  • higher chance of micronutrient deficiencies such as vitamins and calcium


Duodenal Switch (DS)

Duodenal Switch An improvement of the BPD (it is also referred to as “BPD/DS”). Here again, there is a significant malabsorptive component which acts to maintain weight loss long term. The patient must be closely monitored to guard against severe nutritional deficiencies. This procedure, unlike the BPD, keeps the pyloric valve intact. That is the main difference between the BPD and the DS.
Advantages Disadvantages
  • more “normal” absorption of many nutrients than with BPD, including calcium, iron and vitamin B12
  • better eating quality when compared to other WLS procedures
  • eliminates or greatly minimizes most negative side effects of the original BPD
  • essentially eliminates stomal ulcer and dumping syndrome
  • greater chance of chronic diarrhea
  • significant malabsorptive component
  • more foul smelling stools and flatus, but less than with the BPD alone


It is important to remember that there is risk with any surgery.

There are some specific risks associated with Bariatric Surgery.

  • 10-20% of patients who have weight-loss operations require follow-up operations to correct complications. Abdominal hernias are the most common complications requiring follow-up surgery. Less common complications include breakdown of the staple line and stretched stomach outlets.
  • More than one-third of obese patients who have gastric bypass surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery. Many surgeons are opting to remove the gallbladder during the initial weight loss surgery.
  • Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
  • Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Women of childbearing potential should have a pregnancy test before having weight-loss surgery.


Unaltered stomach

The Unaltered Stomach
 
 Stomach – food enters through the esophagus and exits through the pyloric sphincter.
 
 Liver – produces bile salts and filters blood.
 
 Gall Bladder – stores bile salts which are used for the digestion of fats.
 
 Pancreas – secretes digestive enzymes.
 
 Small Intestine – where the majority of all nutritional digestion is performed.
 
 Large Intestine – where mostly water is absorbed into the body.
 
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