| Modality of Weight Loss | Restrictive (Stomach only) | Restrictive and Malabsorptive (Stomach and intestines) | ||
|---|---|---|---|---|
| Type of Operation | Orbera Intragastric Balloon | Lap-Band®(LAGB), REALIZE BAND | Sleeve Gastrectomy (SG) | Roux-en-Y Gastric Bypass (RNY, RGB) |
| Anatomy | Involves placing a non-fixed saline-filled (avg 700 ml) silicone balloon in the stomach, reducing the food-holding capacity and calorie intake. | An adjustable silicone ring (band) is placed around the top part of the stomach creating a small, 15-30ml pouch. | Long narrow vertical pouch measuring 100-150ml. Identical to the duodenal switch pouch but smaller. No intestinal bypass performed. | Small, 15 -25 ml connected to the small intestine.Food and digestive juices are separated for 100-150 cm. |
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| Mechanism | Restricts holding capasity of the stomach and hence the food intake. Short term solution. TGA approved subject to mandatory removal at 6 months | Moderately restricts the volume and type of foods able to be eaten. Only procedure that is adjustable. Delays emptying of pouch. Creates sensation of fullness | Significantly restricts the volume of food that can be consumed. NO malabsorption NO dumping | Significantly restricts the volume of food that can be consumed. Mild malabsorption “Dumping Syndrome” when sugar or fats are eaten |
| Weight Loss Australian Average statistical loss at 10 years | No data. Relatively new procedure. Short term results suggest 12-15 kg weight loss at 6 months | 60% excess weight loss. Requires the most effort of all procedures to be successful. | 60%-70% excess weight loss at 2 years Long term results not available at this time (beyond 6 years) | 70% loss of excess weight More failures (loss of <50% excess weight) than the DS |
| Long Term Dietary Modification Excessive carbohydrate/high calorie intake will defeat all procedures) | Not aplicable | 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 meals | Must consume less than 600-800 calories per day for the first 24 months, 1000-1200 thereafter No dumping, no diarrhea Weight regain may be more likely than in other procedures if dietary modifications not adopted for life | 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 |
| Nutritional Supplements Needed (Lifetime) | Not aplicable | Multivitamin Calcium | Multivitamin, B12 | Multivitamin Vitamin B12 Calcium Iron (menstruating women) |
| Potential Problems | Early: Nausea, vomiting, dehydratoion. Late: Gastric outlet or bowel obstruction if malpositioned or deflated. Inadequate weight loss. Weight regain after removal is possible | Slow weight loss. Slippage, Erosion, Infection, Port problems, Device malfunction | Nausea and vomiting Heartburn Inadequate weight loss Weight regain Additional procedure may be needed to obtain adequate weight loss Leak | Dumping syndrome Stricture Ulcers Bowel obstruction Anemia Vitamin/mineral deficiencies (Iron, Vitamin B12, folate) Leak |
| Hospital Stay | Usually day procedure, but might require stay up to 3-4 days in cases of severe vomiting and dehydration | Overnight | 2 days | 2-3 days |
| Time off Work | 1 week | 1 week | 1-2 weeks | 2-3 weeks |
| Operating Time | 30 min | 45 min | 1.5 hours | 2 hours |
| Our Recommendation | Best for patients with low BMI (usually less than 30-35) requiring a quick, non-invasive solution in shedding 15 kg in a short period (up to 6 months). | Best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions. Many insurance companies will NOT authorize this procedure. | Utilized for high risk or very heavy (BMI > 60 kg/m2) patients as a “first-stage” procedure. Very low complication rate due to quicker OR time and no intestinal bypass performed. | Most effective for patients with a BMI of 40-60 and those with a “sweet-tooth”. |
