| |
Laparoscopic
Adjustable
Gastric Banding |
Laparoscopic
Roux-en-Y
Gastric Bypass |
Laparoscopic Vertical Sleeve Gastrectomy |
| Graphic Representation |
 |
 |
 |
| Anatomy |
An adjustable silicone ring (band) is placed around the top part of the stomach creating a small 15-30 ml pouch. |
Small 7-10 ml gastric pouch is connected to the small intestine bypassing the stomach. Food and digestive juices are separated for 3-5 feet. |
Most of the stomach is removed in a "vertical" fashion leaving a "banana" shaped stomach remnant. |
| Mechanism of Action |
Moderately restricts the volume and type of foods able to be eaten. Band diameter is is adjustable. Must be properly adjusted to create sensation of fullness |
Significantly restricts the volume of food that can be eaten. Mild malabsorption. "Dumping Syndrome" if wrong foods such as sugar or fats are eaten |
Somewhat restricts the volume of food that can be eaten. Also allows food to pass quickly down the gut. Removes the Ghrelin producing cells of the stomach. All these may reduce appetite. |
| What surgical approach is used for each surgery? |
Laparoscopic or minimally invasive (also called by some keyhole surgery) 4 small (7 mm) cuts and one larger (2 cm) cut to place the adjustment port under the skin. |
Laparoscopic or minimally invasive (also called by some keyhole surgery) 5 small (7 mm) cuts are used. No adjustment port therefore avoids the larger 2 cm skin cut. |
Laparoscopic or minimally invasive (also called keyhole surgery by some) 5 small (7 mm) cuts are used. No adjustment port therefore avoids the larger 2 cm skin cut. |
| What Weight Loss can I expect with each? |
50-60% of extra weight lost at 3 years (based on our own data) |
70-80% of extra weight lost at 5 years (based on our own data) |
~55% of extra weight lost at 3 years BUT LONG TERM RESULTS NOT AVAILABLE! |
| Diet-Life Style Changes Required |
Must consume less than 800 calories per day for 18-36 months, 1000-1200 thereafter. Certain foods can get "stuck" if eaten (rice, bread, dense meats, nuts, popcorn) causing pain and vomiting. No drinking with meal (can drink 30 min before and 45 min after) Must exercise (e.g. walk 10,000 steps per day using pedometer) |
Patients must consume less than 800 calories per day in the first 12-18 months; 1000-1200 thereafter 3 small high protein meals per day Must avoid sugar and fats to prevent "Dumping Syndrome" Vitamin deficiency/ protein deficiency usually preventable with supplements Must exercise (e.g. walk 10,000 steps per day using pedometer) |
Patients must consume less than 800 calories per day in the first 12-18 months; 1000-1200 thereafter 3 small high protein meals per day. Vitamin deficiency/ protein deficiency usually preventable with supplements Must exercise (e.g. walk 10,000 steps per day using pedometer) |
| Lifetime Nutritional Supplements Required |
Multivitamin
Calcium |
Multivitamin
Vitamin B12
Calcium
Iron (menstruating women) |
Multivitamin
Calcium |
Risk of Death
and
Short-term and Long-term Complications after each surgery
(These are the statistics of our own bariatric practice and experience) |
SHORT TERM
|
| Death* |
0 % |
| Minor bleeding |
1.1 % |
| Liver/Spleen laceration |
1.8 % |
| Port site infection |
0.9 % |
| Tight band |
0.9 % |
| Camera Port Infection |
0.9 % |
| Chest wall/shoulder pain |
34 % |
| Pulmonary embolus |
0 % |
LONG TERM
|
| Band Slippage |
3 % |
| Band Erosion |
2.8 % |
| Band Leak |
2.8 % |
| Port Leak |
0.9 % |
| Port Disconnection / Tubing break |
2.7 % |
| Failure to lose weight or reach desired weight |
10-30 % |
| Need for additional surgery |
14 % |
| Vitamin/mineral deficiencies |
variable depending on diet |
| Anemia |
6 % |
All case adjustable gastric banding death rate=0.05%
|
| SHORT TERM |
| Death* |
0 % |
| Acute pancreatitis |
0.2 % |
| C. difficile colitis |
0.2 % |
| Colon perforation |
0.2 % |
| Deep vein thrombosis |
0.4 % |
| Internal bleeding |
1.4 % |
| Liver/Spleen laceration |
1.4 % |
| Gastrointestinal leak |
3.6 % |
| Port site infection |
1.2 % |
Myocardial Infarction
|
0.2 % |
| Pulmonary Embolus |
0.2 % |
| Serosal tear of pouch |
0.2 % |
| LONG TERM |
| Stricture of the stomach outlet |
4.0 % |
| Stomach pouch ulcers |
1.4 % |
| Port site hernia |
0.8 % |
| Gastro-gastric fistula |
1.2 % |
| Gallstones |
2.8 % |
| Small bowel fistula |
0.2 % |
| Small bowel obstruction/hernia |
2.6 % |
| Pregnancy first year after surgery |
1.1 % |
| Need for additional surgery |
3 % |
| Vitamin/mineral deficiencies |
variable depending on diet |
| Dumping syndrome |
intentional |
| Anemia |
10 % |
| |
|
|
* - comparing similar cases to Adjustable gastric banding (BMI<55).
All case gastric bypass death rate=0.5%
|
|
| SHORT TERM |
| Death* |
0 % |
| Minor bleeding |
1.5 % |
| Liver/Spleen laceration |
1.4 % |
| Deep vein thrombosis |
0.4 % |
| Gastrointestinal leak |
3.1 % |
| Camera Port infection |
0.9 % |
| LONG TERM |
| Stricture of the stomach outlet |
2.0 % |
| Stomach pouch ulcers |
1.4 % |
| Port site hernia |
0.8 % |
| Gastro-gastric fistula |
1.2 % |
| Gallstones |
2.8 % |
| Need for additional surgery |
20 % |
| Vitamin/mineral deficiencies |
variable |
| Anemia |
10 % |
| |
|
|
* - comparing similar cases to Adjustable gastric banding (BMI<55).
|
|
| How Quickly will I lose the extra weight? |
Weight loss is gradual and may take up to 5 years. Some weight regain seen at this time. |
The lowest weight loss occurs at 2.5 years and followed by some weight regain and stabilization depending on patient compliance with diet and exercise. |
Most of the weight loss occurs within the 1-2 years after surgery. Some weight regain and stabilization occurs after depending on patient compliance with diet and exercise. If the weight loss is not adequate you may need to have a second surgery to convert the VSG to gastric bypass or the full duodenal switch. |
| Average Operating Room Time |
55 min |
70 min |
60 min |
| Length of Hospital Stay |
Overnight (24 h) |
2 days (48 h) |
2 days (48 h) |
| What is the period of convalescence? |
Because this is minimally invasive surgery patients only need to convalesce for 1 - 2 weeks at home
(some patients can return to desk jobs within 1 week of surgery) |
Because this is minimally invasive surgery patients only need to convalesce for 1 - 2 weeks at home
(some patients can return to desk jobs within 1 week of surgery) |
Because this is minimally invasive surgery patients only need to convalesce for 1 - 2 weeks at home
(some patients can return to desk jobs within 1 week of surgery) |
| Where is the surgery performed |
Centre Metropolitain de Chirurgie
(affiliated hospital) |
McGill University Health Center
(public tertiary care center)
or
Centre Metropolotain de Chirurgie
(affiliated hospital) |
McGill University Health Center
(public tertiary care center)
or
Centre Metropolotain de Chirurgie
(affiliated hospital) |
| How long do I wait for the surgery? |
1 month at CMC |
3-7 years at the MUHC
1 month at CMC |
3-7 years at the MUHC
1 month at CMC |
| Who pays for the Surgery? |
Patients must pay out of pocket, financing, or through their insurance. |
At the MUHC Medicare covers the costs.
At CMCP patients must pay out of pocket, through financing, or their insurance. |
At the MUHC Medicare covers the costs.
At CMCP patients must pay out of pocket, through financing, or their insurance. |
| Is the operation reversible? |
YES- Laparoscopic surgery can be done to remove the band. In some cases this can be difficult due to scarring that forms around the band.
It is not recommended except in very unusual circumstances.
Wait regain is almost a certainty. |
YES -Unlike what is stated on some web sites or what you hear from others, laparoscopic surgery can be done to join the new small gastric pouch to the main stomach, since this is not removed at the original surgery.
It is not recommended except in very unusual circumstances. Wait regain is almost a certainty. |
NO- Once the stomach is removed it cannot ge grafted back into the body. |
| Our Recommendations |
Best for patients with BMI=32 kg/m2 (with comorbidity) up to 50 who enjoy participating in an exercise program and are more disciplined and can follow dietary restrictions. Some recent research indicates that is special circumstances patients with BMI as low as 30 may achieve health benefits from weight loss through laparoscopic band surgery. |
Most effective for patients with a BMI of >=35 (with comorbidity) or >40 kg/m2 especially those with a "sweet-tooth".
It takes away the hunger and produces 10-15% more weight loss then AGBD.
It is considered the "Gold Standard Procedure" for weight loss in North America. |
Best for patients with BMI=32 kg/m2 (with comorbidity) up to 50 who enjoy participating in an exercise program and are more disciplined and can follow dietary restrictions. Since we have no data on long term weight loss maintenance, if the weight loss is not adequate you may need to have a second surgery to convert the VSG to gastric bypass or the full duodenal switch. |
| Final Note: |
THE LAPAROSCOPIC BAND MUST BE PROPERLY ADJUSTED TO ACHIEVE THE STATED BENEFITS. PATIENTS MUST MAKE THE COMMITMENT TO RETURN FOR ADJUSTMENTS AND REGULAR FOLLOWUP. |
RYGBP DOES NOT REQUIRE FURTHER ADJUSTMENTS. PATIENTS MUST MAKE THE COMMITMENT TO RETURN FOR REGULAR FOLLOWUP. |
VSG DOES NOT REQUIRE FURTHER ADJUSTMENTS. PATIENTS MUST MAKE THE COMMITMENT TO RETURN TO US OR THEIR HEALTH CARE PRACTITIONER FOR REGULAR FOLLOWUP. |
