Bariatric Procedure Comparison

For the most part these are general characterizations of differences between each procedure to encourage thought and discussion with your bariatric team. Each point could be argued slightly differently by different medical providers. Links to relevant medical literature have been provided for some sections.

Cost and Coverage
Surgery and Hospital Stay
Technical Differences of Each Bariatric Procedure
Expected Weight Loss
Additional Preop Factors to Consider When Picking a Bariatric Procedure
Effects on Obesity-Related Medical Conditions
Post Operative Follow Up
Post Complications
Differences in Quality of Life Measures

Cost and Coverage

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Year First Preformed	1992	1990	1967	1997	2007	1987
How Common in the USA in 2020 (1 most – 6 least)₁	4	1	2	5	6	3
Number Preformed in USA in 2020₁	2,393	122,056	41,280	1,338	488	3,555
Endorsed by the American Society For Metabolic and Bariatric Surgery	Endorsed	Endorsed	Endorsed	Recently Endorsed	Recently Endorsed	Endorsed
How Common at Duke University in 2020 (1 most – 6 least)	None	2	1	None	4	3
Relative Cost of Surgery ($ – $$$$)	$	$$	$$$	$$$	$$$	$$$$
Insurance Coverage₂	Most Cover	All Cover	All Cover	Few Cover	Few Cover	Most Cover
Relative Cost of Vitamins Post-op	$	$$	$$$	$$$$	$$$$	$$$$

1. Estimate of Bariatric Surgery Numbers, 2011-2020 | American Society for Metabolic and Bariatric Surgery
2. Working with Your Insurance Provider: A Guide to Seeking Weight-loss Surgery – Obesity Action Coalition

Surgery and Hospital Stay

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Duration of Surgery (Hours)	0.5 – 2	0.5 – 2	1 – 3	1 – 3	1 – 3	1.5 – 5
Typical Hospital Stay (Days)	0 – 1	1 – 2	1 – 2	1 – 2	1 – 3	1 – 3
Preformed Laparoscopically	Yes	Yes	Yes	Yes	Yes	Yes
Can be performed Robotically	Yes	Yes	Yes	Yes	Yes	Yes
Likelihood of Open Incision	Very Low	Very Low	Very Low	Very Low	Very Low	Very Low
Completely Reversible₁	Yes	No	Yes	Yes	No	No
Partly Reversible	Not Applicable	No	Not Applicable	Not Applicable	Yes	Yes
Operative Risk	+	++	+++	+++	+++	+++

1. A reversal of bariatric surgery implies your anatomy can be surgically restored to near normal. While true, there is a significant risk to reversal operations. The reverse should not be confused with being just like you were before ever having any Bariatric Surgery. There are permanent changes associated with surgery that may forever have related problems.

Technical Differences of Each Bariatric Procedure

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Procedure Restricts Food Intake	Yes	Yes	Yes	Yes	Yes	Yes
Procedure Decreases Absorption of Food	No	No	+	++	+++	++++
Stomach Capacity	Stomach Above Band Approximately 1 oz or an Egg	80% of Stomach Removed	Gastric Pouch About 1 oz or an Egg	Gastric Pouch About 2 – 3 oz	80% of Stomach Removed	80% of Stomach Removed
Roux Limb Length	Not Applicable	Not Applicable	~150 cm	Not Applicable	Not Applicable	~150 cm
Biliopancreatic Limb Length	Not Applicable	Not Applicable	~150 cm	Not Applicable	Not Applicable	Very Long
Common Channel Length	Not Applicable	Not Applicable	Very Long	Not Applicable	Not Applicable	100 – 200 cm
Afferent Limb	Not Applicable	Not Applicable	Not Applicable	~200 cm	Very Long	Not Applicable
Efferent Limb	Not Applicable	Not Applicable	Not Applicable	Very Long	300 cm	Not Applicable
Alimentary Tract Length	Entire Small Intestine	Entire Small Intestine	150 cm Roux Limb + Very Long Common Channel	Very Long Efferent Limb	300 cm Efferent Limb	150 cm Roux Limb + 100 – 200 cm Common Channel

Expected Weight Loss

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
%EWL @ 1 Yea Post Op	+	+++	+++	++++	++++	+++++
%EWL @ 5 Yea Post Op	+	++	+++	++++	?	+++++
%EWL @ 10 Yea Post Op	+	+	++	+++	?	++++
Potential for Inadequate Weight Loss	+++++	++++	+++	++	++	+
Potential for Weight Regain Over Time	+++++	++++	+++	++	++	+

These are relative generalizations based on cumulative data in the literature. Results will vary for each individual.
.ASMBS Position Statement on Medium- and Long-term Durability of Weight Loss and Diabetic Outcomes after Conventional Stapled Bariatric Procedures | American Society for Metabolic and Bariatric Surgery

Additional Preop Factors to Consider When Picking a Bariatric Procedure

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Increased Risk For Smokers/Nicotine Users	+	+	+++	++	+	+
Increased Risk to Oral Steroid Medication Users	+	+	+++	++	+	+
Are NSAIDs allowed after surgery (i.e., Ibuprofen, Advil, Aleve, Motrin, etc…)	In Moderation	In Moderation	Not Allowed	Advise Against	In Moderation	In Moderation
Potential for Decreased Medication Absorption	–	–	+	++	+++	++++
Effect on inflammatory bowel Disease (Ulcerative Colitis, Chrons)	Foreign Body Negative in Chrons	Least Negative Effect	Concern for	+++	++++	++++

Effects on Obesity-Related Medical Conditions

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Metabolic Syndrome Resolution (Includes Diabetes-Type 2, Hypertension, High Cholesterol, Sleep Apnea, and Other Factors)	+	++	+++	++++	+++++	+++++
Gastroparesis	Neutral	Neutral to Improved	Improved	Neutral to Improved	Neutral to Improved	Neutral to Improved
Acid Reflux	Neutral to Improved	Neutral to Significantly Worsened	Improved	Neutral to Worsened	Neutral to Worsened	Neutral to Worsened
Bile Reflux	Neutral to Improved	Neutral	Improved	Neutral to Significantly Worsened	Neutral to Worsened	Improved

Post Operative Follow Up

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Need For Lifelong Follow-up with Bariatric Team₁	Required	Required	Required	Required	Required	Required
Need for Lifelong Bariatric Vitamins₂	Required	Required	Required	Required	Required	Required
Risk of Vitamin Deficiency₂	+	+	++	+++	+++	++++
Risk of Malnutrition₂	+	+	++	+++	+++	++++
Need for Lifelong Bariatric Vitamins₂	Required	Required	Required	Required	Required	Required
Need For Lifelong Additional Vitamin A,D,E,K₂	Not Unless Found to Be Deficient	Not Unless Found to Be Deficient	Not Unless Found to Be Deficient	Not Unless Found to Be Deficient	Required	Required
Need for In-Office Band Adjustments	Required	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable
Life-Long Post-op Endoscopic Screening Required₃	Only if Acid Reflux Symptoms Present	Required	Only if Acid Reflux Symptoms Present	Only if Acid Reflux Symptoms Present	Only if Acid Reflux Symptoms Present	Only if Acid Reflux Symptoms Present
Potential Need for More Surgery Later	+++	+	+++	++	++	+++

1. Life After Bariatric Surgery | Patients | ASMBS
2. AACE/TOS/ASMBS/OMA/ASA Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient – 2020 Update | American Society for Metabolic and Bariatric Surgery
3. ASMBS Position Statement on the Rationale for Performance of Upper Gastrointestinal Endoscopy Before and After Metabolic and Bariatric Surgery | American Society for Metabolic and Bariatric Surgery After bariatric surgery, screening with EGD should be considered for all patients with gastrointestinal symptoms, including GERD symptoms. It is reasonable to perform EGD on patients three years after SG, irrespective of GERD symptoms, to rule out Barrett’s esophagus. More long-term surveillance every five years after that would be reasonable even if the index screening EGD is normal and is compatible with clinicians exercising an abundance of caution until better-designed and longer-term studies are available.

Post Complications

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Ulcer Risk	–	–	+++	++	+	+
Barrets Esophagus	–	+	–	++	+	+
Acid Reflux	Neutral to Improved	Neutral to Significantly Worsened	Improved	Neutral to Worsened	Neutral to Worsened	Neutral to Worsened
Bile Reflux	Neutral to Improved	Neutral	Improved	Neutral to Significantly Worsened	Neutral to Worsened	Improved
Internal Hernia Risk	Not Applicable	Not Applicable	+++	+	+	+++
Reactive Hypoglycemia	Not Applicable	+	++	++	+	+
Alcohol Abuse Risk	Not Applicable	+	++	++	++	++

ASMBS Position Statement on Postprandial Hyperinsulinemic Hypoglycemia after Bariatric Surgery | American Society for Metabolic and Bariatric Surgery

Differences in Quality of Life Measures

	Adjustable Gastric Band	Sleeve Gastrectomy	Roux -en-y Gastric Bypass	One Anastomosis Gastric Bypass	Single Anastomosis Duodenal Ileal Bypass With Sleeve	Duodenal Switch
Dumping Syndrome	Not Applicable	+	++	++	+	+
Fatty Food Intolerance	Not Applicable	+	+	+	++	++
Bowel Habits	No Change	No Change to Constipation	No Change to Constipation	No Change to Constipation	No Change to Diarrhea	No Change to Diarrhea
Foul Gas	Not Applicable	+	+	++	+++	+++