DETAILED COMPARISON OF THE TWO COMMON PROCEDURES PERFORMED BY WLS SURGEONS

Which Bariatric Surgery is Right for You?

You, and only you, can answer this important question after you have considered all the medical evidence and facts about the risks and benefits of each procedure.

You may choose to research weight loss surgery on your own. As with any search for medical information, be sure that your sources are responsible.

Talk to your general practitioner and any specialist that is involved in your care.There is no substitute for consulting with recognized experts in laparoscopic bariatric surgery (such as Dr. Christou or Dr. Chow) who have extensive experience with all the procedures you are considering.

Finally make sure you know the answer to these questions. The side-by-side comparison in the “About our Surgeries” section can help. Write them down and go over the answers several times before you decide.

  1. What is the risk of the worst possible outcome with each procedure?
  2. What are the short-term complications (within 30 days of the surgery) of each procedure?
  3. What are the long-term (basically for the rest of your life) complications of each surgery?
  4. What are the weight loss results in the short term (5 years) and long term (beyond 10 years) after the surgery?
Laparoscopic Gastric Bypass Laparoscopic Sleeve Gastrectomy
Graphic Representation Gastric Bypass Image Sleeve Gastrectomy Image
How is it done? 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.
How does it work? Significantly restricts the volume of food that can be eaten. Mild malabsorption. “Dumping Syndrome” if wrong foods such as sugar or fats are eaten It restricts somewhat the volume of food that can be eaten. It also allows food to pass quickly down the gut. It 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 with 5 small cuts.
No adjustment port therefore avoids the larger 2 cm skin cut.
Laparoscopic or minimally invasive with 5 small cuts are used.
No adjustment port therefore avoids the larger 2 cm skin cut.
What weight loss can I expect with this surgery? ~75% of extra weight lost ~65% of extra weight lost
What diet and life style changes are required of this surgery? Long term goal is to consume 1000-1200 calories in 3 small high protein meals per day. If excess sugar and fats are eaten the operation is designed to cause “Dumping Syndrome” (not pleasant) Vitamin deficiency/ protein deficiency usually preventable with supplements Must exercise (e.g. walk 10,000 steps per day using pedometer) Long term goal is to consume 1000-1200 calories in 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)
Do I require to take nutritional upplements for life after this surgery? Multivitamin
Vitamin B12
Calcium
Iron (menstruating women)
Multivitamin
Calcium
What are the chances I might die from this surgery and are there any other immediate risks?
SHORT TERM
Death* 0 %
Staple line leak 2.1 %
Internal bleeding 1.5%
Colon perforation 0.1 %
Deep vein thrombosis 0.4 %
Liver/Spleen laceration 1.4 %
Port site infection 1.2 %
Heart attack 0.2 %
Pulmonary Embolus 0.2 %

* – These are the statistics of Weight Loss Surgery team’s private practice from 2006-2016 with no surgical mortality in over 1,200 cases

SHORT TERM
Death* 0 %
Staple line leak 2.2%
Minor bleeding 1.5 %
Liver/Spleen laceration 1.4 %
Deep vein thrombosis 0.2 %
 Port Infection 0.9 %

 

What are the long term risks from this surgery?
LONG TERM
Anemia 10 %
Stricture of the stomach outlet 4%
Stomach pouch ulcers 1.4 %
Port site hernia 0.8 %
Gallstones 2.8 %
Small bowel obstruction 2.6 %
Kidney Stones 2 %
Vitamin/mineral deficiencies 2 %
LONG TERM
Anemia 5%
Stricture of the sleeve 2.0 %
Stomach ulcers 1.4 %
Port site hernia 0.8 %
Gallstones 2.8 %
Small bowel obstruction 1%
Kidney stones 2%
Vitamin/mineral deficiencies 1%
How Quickly will I lose the extra weight? Most of the weight loss occurs within the 1-2 years after surgery. The nadir occurs at 1.8 years and followed by some weight regain and stabilization depending on patient compliance with diet and exercise. If you start eating more frequently and inappropriately (most patients start ~ 5 years after the surgery) you can regain significant weight. 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 you start eating more frequently and inappropriately (most patients start ~5 years after the surgery) you can regain significant weight.
How long is the surgery? 75 min 50 min
How long do I stay in hospital? 2 days 1 day
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)
How long do I wait for the surgery? 4-6 weeks, the time needed for proper preparation for safe surgery 4-6 weeks, the time needed for proper preparation for safe surgery
Who pays for the Surgery? Patients must pay out of pocket, through financing, or their insurance. Patients must pay out of pocket, through financing, or their insurance.
Is the operation reversible? 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 get grafted back into the body.
Dr. Christou’s Recommendations Most effective procedure recommended for most patients.It is considered the “Gold Standard Procedure” for weight loss in North America.The majority of our patients chose this procedure. Best for patients with BMI=32-50 kg/m2 (with at least one obesity associated disease like diabetes) who enjoy participating in an exercise program and are more disciplined and can follow dietary restrictions.Dr. Christou’s main reservation is the lack of long term weight loss results.Time will tell!