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WLS Procedures


Type of procedure

Restrictive

Malabsorbtion

Procedure Name

Adjustable Gastric Band
(LAGB)

AKA:  Lap-Band©


 Vertical Banded Gastroplasty
(VBG)

AKA: VBG

"Gastric Stapling"

Gastric Bypass
(GBP)


AKA:

Proximal gastric bypass.

Short limb gastric bypass.

Biliopancreatic diversion. 
(BPD)

AKA: BPD

Scopinaro procedure.

Distal gastric bypass.

Long limb gastric bypass.

Duodenal Switch
(DS)


AKA: DS

 
LAGB VBG GBP BPD DS

Availability

FDA Approved. Will be available through our practice.

 Many centers. 
NIH sanctioned.
Becoming less popular with MDs.

Many centers. NIH sanctioned.

Few centers

Few centers
LAGB VBG GBP BPD DS

Mechanism of action

Limits amount of food that can enter stomach. Induces early satietey

 Limits amount of food that can enter stomach.

Limits amount of food that can enter stomach. Alters flow of nutrients which may aid in early satiety.

Limits number of calories absorbed by shortening effective length of small bowel. Mild restriction of stomach size. Alteration of nutrient flow may induce early satiety.
LAGB VBG GBP BPD DS

Typical percentage of excess weight loss at 5 years

40-50% 
Number of studies limited.

 40-50%

50-70%

60-80%

60-80%
LAGB VBG GBP BPD DS

Relief of comorbid conditions

Good to very good.

 Good to very good.

Very good.

Very good to excellent.

Very good to excellent.
LAGB VBG GBP BPD DS

Advantages

No alteration in metabolism of ingested foods.

 No alteration in metabolism of ingested foods.

Very good balance of weight loss, metabolic side effects, and surgical risk.

Well studied over many years. Very durable results.

No dumping syndrome. Iron deficiency less of a problem. Very durable results
LAGB VBG GBP BPD DS

Ease of reversibility (always requires another surgery).

Relatively straightforward.

 Difficult.

Difficult.

Very difficult. Section of stomach has been removed.

Difficult.
LAGB VBG GBP BPD DS

Surgical risk

Relatively low.

 Low to moderate.

Moderate.

Moderate.

Moderate.

Disadvantages

May not provide adequate weight loss especially for people who persist in snacking and/or eating sweets. Foreign body around stomach with unknown long term (>10yr) effects.

 May not provide adequate weight loss especially for people who persist in snacking and/or eating sweets. Significant failure rate due to staple line breakdown or band problems

Effectiveness limited by snacking. Decreased iron and potential decreased B12 and calcium absorption. Dumping syndrome. 

Real potential for protein and calorie malnutrition. Diarrhea, foul smelling gas. Decreased iron and potential decreased B12 and calcium absorption. Dumping syndrome. Kidney stones.

Real potential for protein and calorie malnutrition. Diarrhea, foul smelling gas. Kidney stones.
LAGB VBG GBP BPD DS

Supplements

Multivitamins.

 Multivitamins.

Iron, calcium, B12, multivitamins.

Iron, calcium, B12, multivitamins, protein.

Calcium, protein, multivitamins. Iron, B12.

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