| TYPE OF SURGERY |
LAPAROSCOPIC ADJUSTABLE GASTRIC BAND |
ROUX-EN-Y GASTRIC BYPASS |
| COMPARISON BEFORE SURGERY |
|
| Approach to Weight Loss |
Restrictive
| • |
Limits food intake |
| • |
Slows food transit |
| • |
Earlier satiety |
|
Restrictive and Malabsorptive
| • |
Limits food intake |
| • |
Limits calorie absorption |
|
| Suitability for Surgery |
| • |
Not prone to snacking on crisps, chocolate, ice cream etc |
| • |
Patients with poor weight control |
| • |
Commitment to losing weight post-operatively through non-surgical
methods e.g. exercise, diet |
|
| • |
Prone to snacking heavily |
| • |
Has co-morbidities e.g. diabetes |
| • |
Need for significant weight loss |
| • |
More complicated cases |
|
| Prices from |
|
|
| Pre-op Diet |
Milk Diet + Vitamins
| • |
Varies from 1-2 weeks depending on complexity of case |
| • |
Low carbohydrate diet if milk intolerant |
|
Milk Diet + Vitamins
| • |
Varies from 1-2 weeks depending on complexity of case |
| • |
Low carbohydrate diet if milk intolerant |
|
| |
|
|
| COMPARISON DURING SURGERY |
|
| Anatomy Change |
Stomach
| • |
Small pouch created by reversible band |
|
Stomach and Intestines
| • |
Small stomach pouch created by permanent dissection |
| • |
Shortened small intestine due to bypass of the duodenum |
|
| Length of Operation |
1 hour |
2-3 hours depending upon patient complexity |
| Additional Procedures |
None |
| • |
Cholecystectomy |
| • |
Apronectomy |
| • |
Hernia repair |
|
| Mortality |
1 in 2000 |
1 in 300 |
| |
|
|
| COMPARISON AFTER SURGERY |
|
| Average Length of Hospital Stay |
Day
stay / 1 night |
2 / 3 nights |
| Expected Weight Loss |
50% of excess weight in 12-18 months post-operatively |
70% of excess weight in 12-18 months post-operatively |
| Possible Complications |
| • |
Band slippage/twisting + stomach obstruction |
| • |
Infection |
| • |
Erosion into stomach |
| • |
Injury to stomach and nearby organs |
|
| • |
Infection |
| • |
Internal bleeding |
| • |
Leakage from the stapled sites |
| • |
Blood clots (DVT/PE) |
| • |
Breathing difficulties |
| • |
Pain |
| • |
Vitamin and mineral deficiencies |
| • |
Heartburn |
| • |
Bowel obstruction |
|
| Reversible? |
Yes |
No- Revisions are possible |
| Follow Ups |
Band adjustments depending on progress |
Regular appointments to monitor weight loss |
| Scarring |
Limited |
Limited, but larger scars if performed openly |
| Dumping Syndrome |
Rare |
Controlled if dietary guidelines followed |
| Dietary Guidelines |
| • |
Liquid puree diet for first week progressing to bulkier items. |
| • |
Avoid foods that quickly dissolve into liquids e.g. sauces, sweets and chocolate |
|
| • |
Sloppy/puree diet for 2 weeks progressing onto a mashed diet |
| • |
Child sized portions expected by a year post-op |
| • |
Lifelong vitamin supplementation required |
|
| Time off Work |
1 week |
2-3 weeks |
| Benefits of Surgery |
| • |
Short hospital stay |
| • |
Reversible and adjustable |
| • |
Simple and safe procedure |
| • |
Quick recovery |
| • |
Low malnutrition risk |
|
| • |
Rapid weight loss |
| • |
No adjustments required |
| • |
Co-morbidities improve (e.g. diabetes) |
| • |
Food control becomes much easier |
| • |
Limited calories absorbed |
|
