• Overview
• Common to All of the Bariatric Procedures
• Bariatric Procedures Endorsed by the American Society for Metabolic and Bariatric Surgery
  • Sleeve Gastrectomy
  • Roux-en-y Gastric Bypass
  • One Anastomosis Gastric Bypass
  • Single Anastomosis Duodenal Ileal Bypass With Sleeve
  • Duodenal Switch
  • Adjustable Gastric Band
• Should I have a malabsorptive procedure
• Bariatric Procedure Comparison Chart
• Bariatric Surgery Weight Loss Estimator
• Select Research Papers

Overview

Common to All of the Bariatric Procedures

•  Low peri-operative risk when compared to other common surgical procedures. In the long run add years to life for most.
  • Long-term mortality after gastric bypass surgery – PubMed
• Typically performed in a minimally invasive fashion (i.e., laparoscopic or robotic). Most require 4 – 5 small incisions between 1 – 2 cm in length.
• Short hospital Stay – Many low-risk patients will go home the day after surgery, and some centers perform the procedures as totally outpatient. Even for patients with significant health concerns, the hospital stay is often remarkably short. 
• Mandatory lifelong follow-up. The typical follow-up schedule is a one to three week post-op visit, three-month post-op visit, six-month post-op visit, one-year post-op visit, and yearly for the rest of your life.
• Requires lifelong adherence to post-bariatric surgery diet and exercise regimen.
• Requires mandatory vitamins for life. You will need to have at least yearly blood work for life to evaluate and correct vitamin levels. Some procedures require more vitamins than others.
• Results in significant, durable weight loss when compared to behavioral weight loss. Each procedure will vary with the average amount and durability of weight loss. 
• Results in improvement or resolution of obesity-related co-morbidities. Each procedure will vary with the magnitude of resolution or improvement for each condition.
• Require significant dietary changes, including adopting healthy eating patterns on the path to surgery, liver shrinking diet in weeks leading up to surgery, a liquid diet for couple weeks after surgery, a soft food diet in the first several months after surgery, and an on-going healthy diet emphasizing high protein for life.

Sleeve Gastrectomy

Also Know As: Sleeve, Vertical Sleeve Gastrectomy, VSG, SG

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What is a Sleeve Gastrectomy?

The stomach is stapled and cut, permanently removing approximately eighty percent of the stomach, leaving the remains stomach to resemble a banana shape, referred to as a sleeve.

How Does it Work?

It restricts the amount of food eaten and speeds the passage of food through the stomach triggering gut hormones responsible for fullness, and metabolism. While decreasing a hormone felt to be responsible for hunger.

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Advantages

1. Technically simple and shorter surgery time
2. It can be performed on certain patients otherwise with high-risk prohibitive medical conditions.
3. It may be performed as the first step for patients with severe obesity.
4. Effective weight loss and improvement of obesity-related conditions
5. Doesn’t use a foreign device like the Adjustable Gastric Band
6. Doesn’t reroute the small intestine like many of the other procedures; thus no potential for internal hernias at small bowel connections.
7. Surgically less complex with fewer initial complications when compared to Roux-en-y Gastric Bypass, One Anastomosis Gastric Bypass, Single Anastomosis Duodenal Ileal Bypass With Sleeve, and Duodenal Switch.
8. Of all the bariatric surgeries, it’s most easily converted to another procedure down the line if required for inadequate weight loss, weight regain, or inadequate co-morbidity resolution.
9. Vitamin deficiencies can and do occur; thus, lifelong bariatric vitamins are required. However, compared to the more malabsorptive procedures, their onset is often less rapid, with a longer timeline before becoming severe and permanent.
10. Less incidence of dumping syndrome or fatty food intolerance than more malabsorptive procedures.
11. Since food travels through the entire small intestine where absorption occurs, this has the least impact on medication absorption, which could make a difference in select groups of patients with conditions like post-organ transplantation or fragile mental health medication regimen.
12. All patients should stop smoking before surgery to lower the risk. Sleeve Gastrectomy is less prone to long-term complications from tobacco use if smoking resumes down the line.

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Disadvantages

1. Non-reversible procedure
2. Less impact on weight loss compared to bypass procedures that alter small intestine anatomy. Initial weight loss is comparable to Roux -en-y Gastric Bypass at 5 years out from surgery, but weight loss seems less durable as move out 5 – 10 years from surgery. Leading to a higher need for a second-stage procedure converting the sleeve to another bariatric surgery.
3. Less impact on many obesity-related co-morbidities when compared to the procedures that alter the small intestine anatomy. For example, with Type 2 diabetes, Sleeve Gastrectomy and Roux -en-y Gastric Bypass result in similar reductions in a patient’s hemoglobin A1C level ( a marker for diabetes control). However, Sleeve Gastrectomy patients needed to remain on more diabetic medications and insulin than Roux -en-y Gastric Bypass patients.
   • Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes
4. Controversial data regarding acid reflux. 7-10% of patients who don’t previously have acid reflux develop it post-op. Of those with acid reflux before surgery, the data is a bit confusing, but a moderate number of patients see their acid reflux improve. Many stay the same, but a few worsen and require another procedure to resolve the reflux. Patients with moderate to large Hiatal hernias are potentially at greater risk of acid reflux post-op. Recent research suggests a 17% incidence of Barrett’s esophagus after surgery which is a precursor to esophageal cancer, so life-long screening with EGD is recommended.
   • Considerations on the role of esophagogastroduodenoscopy in the pediatric metabolic and bariatric surgery patient
   • ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery
5. Gastric Leaks after a Sleeve Gastrectomy can be more difficult to resolve. This results from the high intraluminal pressure within the proximal sleeved stomach.
   • ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

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Roux -en-y Gastric Bypass

Also Know As: Gastric Bypass, Bypass, RYGB, Roux-en-Y, the Gastric, the “Y” Procedure

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What is Roux -en-y Gastric Bypass?

The Roux-en-Y Gastric Bypass, or gastric bypass, was first performed in 1967, and the laparoscopic approach has been refined since 1993. It is one of the most common operations and effectively treats obesity and obesity-related diseases. The name is a French term meaning “in the form of a Y.”

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The Procedure Steps

1. Shows normal gastrointestinal tract before any procedure has begun
2. A surgical stapler (Links to the two major suppliers in the United States Surgical Staples | Skin Stapler | Ethicon Product Portfolio | Obesity & Metabolic Health | Medtronic ) is used to cut and divide the stomach at the red dotted line.
3. This results in a small gastric pouch which is ideally less than 5 cm long and 5 cm wide. The remainder of the stomach, referred to as the gastric remnant, is not removed. It stays in place and continues to produce gastric acid and juices that will be important to help digest and absorb food. At this point, clearly, something must be done so food can get out of the gastric pouch. A roux limb is created (see Roux-en-Y verse Loop Small Intestine Reconfiguration) by dividing the small intestine at the red dotted line.
4. Once the small intestine is divided, we have two sides. The distal end labeled “B” can be pulled up to create a roux limb that drains the small gastric pouch.
5. A connection is made between the roux limb and the gastric pouch. After the small bowel is divided in step three, the proximal bowel that connects the gastric remnant is called the Biliopancreatic or BP limb. The BP limb is reconnected further down the small intestine in a connection called the jejuno-jejunostomy (JJ anastomosis), which forms the “Y” connection.
6. Completed Roux-en-y Gastric Bypass procedure.

How it Works?

The gastric bypass works in several ways. Like many bariatric procedures, the newly created stomach pouch is smaller and able to hold less food, which means fewer calories are ingested. Additionally, food absorption is altered in both the BP and roux limbs. This results in decreased absorption. Most importantly, the modification of the food course through the gastrointestinal tract has a profound effect on hormones to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. The impact on hormones and metabolic health often results in the improvement of adult-onset diabetes even before any weight loss occurs. The operation also helps patients with reflux (heartburn), and often the symptoms quickly improve. Along with making appropriate food choices, patients must avoid tobacco products and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

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Advantages

1. Studied extensively over several decades
2. Reliable and long-lasting weight loss 
3. More Effective for the remission of obesity-associated conditions when compared to Sleeve Gastrectomy or Adjustable Gastric Band.
4. A refined and standardized technique
5. Often considered the procedure of choice for patients with moderate to large Hiatal hernias, severe acid reflux, or gastroparesis.
6. While all bariatric procedures require lifelong compliance with dietary and behavioral guidelines, the onset of severe malnutrition or vitamin deficiency is often slower onset for non-compliant patients when compared to One Anastomosis Gastric Bypass, Single Anastomosis Duodenal Ileal Bypass With Sleeve, or Duodenal Switch.
7. Dumping Syndrome – While considered by some a disadvantage, dumping syndrome can be very beneficial in helping patients avoid triggering foods high in sugar and carbohydrates. When dumping occurs, it’s temporary and unpleasant, causing bloating, abdominal pain, nausea, diarrhea, sweating, and facial flushing. However, experiencing dumping help make changes in cravings within the brain, aiding in following dietary guidelines.
8. Reversible

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Disadvantages

1. Technically more complex when compared to sleeve gastrectomy or gastric band
2. More vitamin and mineral deficiencies than sleeve gastrectomy or gastric banding
3. There is a risk for small bowel complications and obstructions from internal hernias at 2 locations.
4. There is a significant risk of developing marginal ulcers, especially with non-steroidal anti-inflammatory drugs (NSAIDs), tobacco, or oral steroid use. These products are not to be used after Roux -en-y Gastric Bypass.
5. Higher risk for future post-op procedural intervention (i.e., EGD or surgery ) to evaluate for a potential complication like marginal ulcers or internal hernia in the years after surgery.
6. If inadequate weight loss or future weight regain can be revised or converted to another procedure. However, the most common revision options are often technically demanding and result in suboptimal outcomes.

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One Anastomosis Gastric Bypass

Also Know As: Mini Gastric Bypass, Loop Gastric Bypass, Omega Loop, Loop Bypass, the “Mini”

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What is One Anastomosis Gastric Bypass?

In 1997 a trauma surgeon repaired a gunshot wound that required a stomach and bowel reconstruction technique that led to weight loss and the development of a procedure he initially called the “mini gastric bypass.” Due to this particular surgeon’s personal patient care struggles, the procedure was very controversial in the United States and never gained traction. However, the procedure began to flourish outside the United States and is now the third most common bariatric procedure performed across the world. Recently, in 2022 the American Society for Metabolic and Bariatric Surgery reviewed the world research literature and approved the procedure as a standard accepted procedure. Insurance companies lag behind, and many do not cover One Anastomosis Gastric Bypass.

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The Procedure Steps

1. Shows normal gastrointestinal tract before any procedure has begun
2. A surgical stapler (Links to the two major suppliers in the United States Surgical Staples | Skin Stapler | Ethicon Product Portfolio | Obesity & Metabolic Health | Medtronic ) is used to cut and divide the stomach at the red dotted line. As compared to a Roux -en-y Gastric Bypass, the gastric pouch is purposely made significantly longer to prevent bile reflux to which One Anastomosis Gastric Bypass is susceptible.
3. The small intestine is measure down approximately 200 cm from the stomach and loop of intestine is selected to be attached to the gastric pouch.
4. The loop of intestine is attached to the gastric pouch. The proximal bowel leading up to the connection is referred to as the afferent limb. The distal bowel beyond the connection is called the efferent limb.

How it Works?

The One Anastomosis Gastric Bypass works in several ways. Like many bariatric procedures, the newly created stomach pouch is smaller and able to hold less food, which means fewer calories are ingested. Additionally, food absorption is altered because it no longer flow through the afferent limb. This results in decreased absorption. Most importantly, the modification of the food course through the gastrointestinal tract has a profound effect on hormones to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. The impact on hormones and metabolic health often results in the improvement of adult-onset diabetes even before any weight loss occurs. The loop anatomy has less risk of marginal ulcer when compared to Roux -en-y Gastric Bypass due to the elevated pH of the bile buffering acid that dumps out of the gastric pouch onto the at risk small intestine lining which doesn’t have the same protective lining as the stomach. However, the same bile can reflux up into the stomach and esophagus causing an uncomfortable condition called bile reflux.

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Advantages

1. Reliable and long-lasting weight loss. Most studies demonstrate greater weight loss than Roux -en-y Gastric Bypass
2. Effective for the remission of obesity-associated conditions. Higher rates of diabetes remission than Roux -en-y Gastric Bypass
3. Dumping Syndrome – While considered by some a disadvantage, dumping syndrome can be very beneficial in helping patients avoid triggering foods that are high in sugar and carbohydrates. When dumping occurs, it’s temporary and unpleasant, causing bloating, abdominal pain, nausea, diarrhea, sweating, and facial flushing. However, experiencing dumping help make changes in cravings within the brain, aiding in following dietary guidelines.
4. Only one small intestine connection so fewer locations for leaks and only one potential spot for internal hernias later.
5. Quicker to perform than Roux -en-y Gastric Bypass
6. Lower risk for marginal ulcers when compared to Roux -en-y Gastric Bypass.
7. Lower risk for severe vitamin deficiency and malnutrition when compared to Single anastomosis duodeno–ileal bypass with sleeve gastrectomy and Duodenal Switch.
8. Reversible

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Disadvantages

1. While common outside the United States, it’s only recently approved as a standard procedure by the American Society for Metabolic and Bariatric Surgery. As a result most US surgeons have very little experience with this procedure. It’s technically quite similar to other common bariatric procedures but surgeons will go through some learning curve adding it to their repertoire.
2. Very limited insurance coverage.
3. Moderate risk of bile reflux and its potential consequences.
4. Higher rates of vitamin deficiencies and malnutrition than Adjustable Gastric Band, Sleeve Gastrectomy, or Roux -en-y Gastric Bypass. Should I have a malabsorptive procedure?

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Single Anastomosis Duodenal Ileal Bypass With Sleeve

Also Know As: Stomach Intestinal Pylorus-Sparing Surgery, SIPS, Loop DS, SAIDI-S, SAIDI

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What is Single Anastomosis Duodenal Ileal Bypass With Sleeve?

The Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy, referred to as the SADI-S is a relatively new form of the Duodenal Switch. The SADI-S is simpler and takes less time to perform as there is only one surgical bowel connection.

The Procedure Steps

1. Shows normal gastrointestinal tract before any procedure has begun
2. A Sleeve Gastrectomy is performed on the stomach.
3. The first part of the small intestine known as the duodenum is divided just after the stomach.
4. A loop of the intestine, identified by counting back from the distal end of the small intestine about 300 cm or just shy of 10 feet, is connected to the stomach. This is the only intestinal connection performed in this procedure.

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How it Works?

When the patient eats, food goes through the pouch and directly into the latter portion of the small intestine. The food then mixes with digestive juices from the first part of the small intestine. This allows enough absorption of vitamins and minerals to maintain healthy levels of nutrition. This surgery offers good weight loss along with less hunger, more fullness, blood sugar control, and diabetes improvement.

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Advantages

1. Has gastric restriction from Sleeve Gastrectomy portion and bypasses more small intestine than Roux -en-y Gastric Bypass or One Anastomosis Gastric Bypass resulting in greater hormonal effect allowing for more weight loss, the durability of weight loss, and improvement in obesity-related co-morbidities.
2. Small bowel connection beyond the pylorus decreases the risk of a marginal ulcer when compared to Roux -en-y Gastric Bypass or One Anastomosis Gastric Bypass. Similarly, the post-pylorus connection decreases the risk of bile reflex when compared to One Anastomosis Gastric Bypass.
3. Decreased incidence of dumping syndrome.
4. Only one small intestine connection, so there are fewer locations for leaks and only one potential spot for internal hernias later.
5. Quicker to perform than Duodenal Switch.
6. Less risk of vitamin deficiency and malnutrition than with Duodenal Switch.

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Disadvantages

1. Vitamins and minerals are not absorbed as well as in the Adjustable Gastric Band, Sleeve Gastrectomy, Roux -en-y Gastric Bypass, or One Anastomosis Gastric Bypass. Requires extra daily vitamins above and beyond what is required with Adjustable Gastric Band, Sleeve Gastrectomy, Roux -en-y Gastric Bypass, and One Anastomosis Gastric Bypass. The extra vitamins result in higher out-of-pocket expenses per month. Vitamin deficiencies and their sometimes severe permanent consequences come on quickly with even relatively short periods of not taking your vitamins. Should I have a malabsorptive procedure?
2. Very Limited insurance coverage since recently adopted as a standard bariatric surgery by the American Society for Metabolic and Bariatric Surgery.
3. Newer operation with only short-term outcome data.
4. When you look at the frequency of the different bariatric surgeries, you find Single Anastomosis Duodenal Ileal Bypass With Sleeve and Duodenal Switch is not performed nearly as commonly as Sleeve Gastrectomy or Roux -en-y Gastric Bypass. Many experienced bariatric surgeons had not been trained to laparoscopically dissect around the duodenum, an area of complex anatomy. As a result, many surgeons are in their learning curve for Single Anastomosis Duodenal Ileal Bypass With Sleeve and Duodenal Switch, which can increase risk.
5. Potential to worsen or develop new-onset acid or bile reflux. Requires screening endoscopy to be performed periodically after surgery to watch for the development of Barretts Esophagus.
   • Considerations on the role of esophagogastroduodenoscopy in the pediatric metabolic and bariatric surgery patient
   • ASMBS position statement on the rationale for the performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery
6. Risk of looser, more frequent bowel movements, and foul-smelling gas, especially when eating food high in fat.
   • Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
7. It can make the removal of the gallbladder more difficult if develop gallbladder problems associated with weight loss, so some surgeons routinely remove it at the time of surgery.
   • Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery

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Duodenal Switch

Also Know As: Biliopancreatic Diversion, Biliopancreatic Diversion Duodenal Switch, BPD-DS, DS, Standard DS, Roux -en-Y DS

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What is Duodenal Switch?

Variations of the modern duodenal switch were performed as early as the 1970s, so we have long-term research studies on its results.  It bypasses more small intestines than any of the other bariatric procedures producing the most significant hormonal effects and resulting in the most weight loss and most durable weight loss.  It also results in the greatest resolution of obesity-related medical conditions.

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The Procedure Steps

1. Shows normal gastrointestinal tract before any procedure has begun
2. A Sleeve Gastrectomy is performed on the stomach.
3. The first part of the small intestine, the duodenum, is divided just after the stomach. At this point, clearly, something must be done so food can get out of the divided duodenum. A roux limb is created (see Roux-en-Y verse Loop Small Intestine Reconfiguration) by dividing the small intestine at the red dotted line. Once the small intestine is divided, we have two sides. The distal end labeled “B” can be pulled up to create a roux limb that can drain the duodenum.
4. A connection is made between the roux limb and the duodenum. After the small bowel is divided in step three, the proximal bowel that connects the gastric remnant is called the Biliopancreatic or BP limb. The BP limb is reconnected further down the small intestine in a connection called the jejuno-jejunostomy (JJ anastomosis), which forms the “Y” connection.
5. Completed Duodenal Switch procedure.

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How it Works?

The smaller stomach, shaped like a banana, allows patients to eat less food. The food bypasses roughly 75% of the small intestine. This results in a significant decrease in the absorption of calories and nutrients. Patients must take vitamins and mineral supplements after surgery. Even more than gastric bypass and sleeve gastrectomy, the Duodenal Switch affects intestinal hormones in a manner that reduces hunger, increases fullness, and improves blood sugar control. The Duodenal Switch is considered to be the most effective approved metabolic operation for the treatment of type 2 diabetes.

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Advantages

1. Studied extensively over several decades
2. Has gastric restriction from the sleeve gastrectomy portion of the procedure and bypasses more small intestine than any other bariatric procedure resulting in the greatest hormonal effect allowing for maximal weight loss, the durability of weight loss, and improvement in obesity-related co-morbidities.
3. Small bowel connection beyond the pylorus decreases the risk of a marginal ulcer compared to Roux -en-y Gastric Bypass or One Anastomosis Gastric Bypass.
4. The post pylorus connection and roux -en-y small intestine reconfiguration decreases the risk of bile reflex compared to One Anastomosis Gastric Bypass or Single Anastomosis Duodenal Ileal Bypass With Sleeve.
5. Decreased incidence of dumping syndrome.

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Disadvantages

1. Has slightly higher complication rates and the potential for longer hospital stays than other procedures.
2. When you look at the frequency of the different bariatric surgeries, you find Duodenal Switch is not performed nearly as commonly as Sleeve Gastrectomy or Roux -en-y Gastric Bypass. Many experienced bariatric surgeons had not been trained to laparoscopically dissect around the duodenum, an area of complex anatomy. As a result, many surgeons are in their learning curve for Duodenal Switch, which can increase risk.
3. More malabsorption than any of the other bariatric procedures. Requires extra daily vitamins above and beyond what is required with Adjustable Gastric Band, Sleeve Gastrectomy, Roux -en-y Gastric Bypass, and One Anastomosis Gastric Bypass. The extra vitamins result in higher out-of-pocket expenses per month. Vitamin deficiencies and their sometimes severe permanent consequences come on quickly with even relatively short periods of not taking your vitamins. Should I have a malabsorptive procedure?
   • AACE/TOS/ASMBS/OMA/ASA Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient – 2020 Update
4. Patients often get enamored by the large amount of weight loss. The pursuit of more weight loss often causes patients to overestimate their ability to be compliant with the mandatory lifelong vitamin and nutritional regimen resulting in a higher reoperation rate down the line to reverse the procedure when they develop severe vitamin deficiencies and or malnutrition.
5. Potential to worsen or develop new-onset acid reflux. Requires screening endoscopy to be performed periodically after surgery to watch for the development of Barretts Esophagus.
   • Considerations on the role of esophagogastroduodenoscopy in the pediatric metabolic and bariatric surgery patient
   • ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery
6. Risk of looser, more frequent bowel movements, and foul-smelling gas, especially when eating foods high in fat.
   • Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch
7. It can make removal of the gallbladder more difficult if develop gallbladder problems associated with weight loss, so some surgeons routinely remove it at the time of surgery.
   • Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery
8. More complex surgery requires more operative time. Increased operative time can increase the risk for certain complications, including rhabdomyolysis and blood clots.

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Adjustable Gastric Band

Also Know As: Lap Band, Band

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What is an Adjustable Gastric Band?

The surgery involves the placement of an inflatable silicone band around the upper part of the stomach, creating a small pouch that can hold only a small amount of food. The band can be adjusted by injecting or removing saline solution through a small port placed under the skin.

Adjustable gastric bands are designed to restrict the amount of food that the stomach can hold and slow the passage of food through the stomach, which can help to reduce appetite and promote weight loss.

The procedure is generally less invasive than other types of bariatric surgery, and recovery time is typically shorter. However, it is also associated with a lower rate of weight loss compared to other bariatric procedures and requires frequent adjustments to be effective.

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The Procedure Steps

1. Adjustable Gastric Bands are devices sold by companies. In the United States, currently, there is only one available Adjustable Gastric Band.
2. The surgeon tunnels the gastric band through a layer of fat behind the stomach around the upper part of the stomach, creating a small pouch that can hold only a small amount of food.
3. The upper portion of the stomach, known as the fundus, is sewn over the band to secure it in position.
4. The band is connected to a small port placed under the skin. This port is used to adjust the tightness of the band by injecting or removing saline solution.

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How it Works?

When food is consumed, it passes through the small pouch and into the rest of the stomach, where it is digested and absorbed as normal. However, because the pouch can hold only a small amount of food, the person feels full more quickly, which can help to reduce the amount of food they eat. The band also slows the passage of food through the stomach, which can help to reduce appetite and promote weight loss.

Adjustable gastric bands are typically used with lifestyle changes, such as diet and exercise, to help people lose weight and maintain a healthy weight over the long term.

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Advantages

1. It doesn’t involve dividing any of the gastrointestinal tract so the risks of complications are generally lower around the time of surgery.
2. Typically performed as an outpatient procedure with no hospital stay.
3. It is reversible, meaning that the band can be removed if necessary.
4. It may be an option for people who are not eligible for other types of bariatric surgery due to medical conditions or other risk factors.
5. Weight loss is slower than with other procedures, which some patients desire.

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Disadvantages

1. Weight loss may be less and slower with adjustable gastric band surgery compared to other bariatric procedures.
2. The band may need to be adjusted frequently to be effective, which can be inconvenient and may require additional surgery.
3. There is a long-term risk of unique band-related complications, such as band slippage or erosion, which can require additional surgery to repair.
4. The band may not be as effective at reducing the risk of obesity-related conditions such as diabetes, high blood pressure, and sleep apnea as other bariatric procedures.
5. Only one Adjustable Gastric Band company is available in the United States. The device has been sold and passed between several companies in recent years, leaving questions about its longevity in the market.
6. Adjustable Gastric Band was very popular around 2010 but has subsequently dropped off dramatically in popularity with surgeons and patients. The end result is fewer surgeons offering or with experience with Adjustable Gastric Bands.

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You should not experience significant pain, vomiting, food intolerance, or heartburn after a band adjustment. If these symptoms develop contact your bariatric team

Select Research Papers

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• Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial
• Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial
• Evaluation of Metabolic Outcomes Following SADI-S: a Systematic Review and Meta-analysis
• Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial
• Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial
• Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis
• Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding
• Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review
• Single Versus Double Anastomosis Duodenal Switch in the Management of Obesity: A Meta-analysis and Systematic Review
• Long-term (>10 Yrs) Outcome of the Laparoscopic Biliopancreatic Diversion With Duodenal Switch
• American Society of Metabolic and Bariatric Surgery consensus statement on laparoscopic adjustable gastric band management
• Laparoscopic adjustable gastric band remains a safe, effective, and durable option for surgical weight loss

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