Detailed Comparison of Our Procedures

Laparoscopic Gastric Bypass Laparoscopic Sleeve Gastrectomy
Graphic Representation Gastric Bypass Image Sleeve Gastrectomy Image
How is it done? Small 30-40 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 reduces production of the ghrelin hormone by the stomach thus reducing appetite. 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 hormone 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 fewer calories in 3 small high protein meals per day. If excess sugar and fats are eaten the operation is designed to cause the unpleasant dumping syndrome. Vitamin deficiency/ protein deficiency usually preventable with supplements. Must exercise intensely e.g. walk 10,000 steps daily Long term goal is to consume fewer calories in 3 small high protein meals per day. Vitamin deficiency/ protein deficiency usually preventable with supplements. Must exercise intensely e.g. walk 10,000 steps daily
Do I require to take nutritional supplements for life after this surgery? Multivitamin, Vitamin B12, Calcium, Iron (menstruating women) Multivitamin, Vitamin B12, Calcium, Iron (menstruating women)
What are the chances I might die from this surgery and are there any other immediate risks?
SHORT TERM (30 day)
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 Dr. Chow and Dr. Christou’s statistics in private practice from 2006-2020 in over 1,500 cases
SHORT TERM (30 day)
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
Severe Anemia 10 %
Stricture of the stomach outlet 4%
Stomach pouch ulcers 1.4 %
Port site hernia 0.8 %
Gallstones (10 years) 14.4 %
Small bowel obstruction 2.6 %
Kidney Stones 2 %
Vitamin/mineral deficiencies 2 %
LONG TERM
Severe Anemia 5%
Stricture of the sleeve 2.0 %
Stomach ulcers 1.4 %
Port site hernia 0.8 %
Gallstones (10 years) 17.3 %
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, since nothing is removed during original surgery. It is not recommended except in very rare and unusual circumstances; with reversal weight regain is almost a certainty. No, once the stomach is removed it cannot get grafted back into the body.
Our Recommendation Most effective procedure recommended for most patients. It is considered the “gold standard bariatric procedure” for weight loss in North America as it has been performed for over 60 years, with resulting long term data. The majority of our patients choose this procedure. An excellent option for patients of all BMI’s. It can be used as an option in first step surgery for super obesity (BMI > 50), followed by a second step revision if necessary. Our main reservation is the lack of long term (past 30 years) weight loss results.
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Roux-en-Y Gastric Bypass Vertical Sleeve Gastrectomy Duodenal Switch One Anastomosis Gastric Bypass Single Anastomosis Duodenal Ileostomy
Anatomy Gastric Bypass Realize ENG VSG Realize ENG PPDDS_ENG_REALIZE OAGB SADI
Worldwide popularity  Most common(“Gold Standard”)  New Procedure Becoming popular  <2%  <2% ?
Hospital stay  2 days  1 day  2-3 days  2 days 2 days
Return to work  2 weeks  2 weeks  2 weeks 2 weeks 2 weeks
Surgery reversible  YES  NO  NO  YES  NO
Eliminate hunger  YES YES YES  YES YES
Risk of 30 day mortality  0 – 0.5%  0 – 0.5%  0 – 1.6%  0 – 0.5%  Unknown as yet
Average weight loss 1 year after surgery  70% of excess weight  55% of excess weight  75% of excess weight Unknown as yet Unknown as yet
Time to maximum weight loss  18 months  2 years  18 months 18 months 18 months
Risk of weight regain  +  ++  + ++ Unknown as yet
Type-2 diabetes control  +++  ++  ++++  ++  Unknown as yet
High blood pressure control  +++  ++  +++  ++  Unknown as yet
Cholesterol control  +++  ++  ++++  +  Unknown as yet
Sleep apnea control  +++  ++  +++  + Unknown as yet
 Lifelong complications Anemia ++ VitaminDeficiency ++Kidney Stones +Dumping if dietary advice not followed Anemia ++ Vitamin Deficiency ++ Anemia +++ Vitamin Deficiency +++ Kidney Stones ++ Low Albumin + Frequent bowel movements +++ Anemia ++ Vitamin Deficiency ++ Kidney Stones +Bile refluxDumping if dietary advice not followed Unknown as yet
 Our recommendations Recommended  for all patients for the advantage of long term durability.
Considered the “gold standard bariatric procedure” for weight loss in North America.
The majority of our patients choose this procedure.
An excellent option for patients of all BMI’s. It can be used as an option in first step surgery for super obesity (BMI > 50), followed by a second step revision if necessary. Our main reservation is the lack of long term (past 30 years) weight loss results.
This is our second most popular procedure.
Best for super obesity patients with BMI>60 kg/m 2 who accept certain inconveniences like frequent soft bowel movements, foul smelling flatulence, increased risk of vitamin deficiencies.
Our main reservation is the need for rigid adherence to diet supplements which most patients fail to follow long term, as well as the associated unpleasant side effects.
Lack of 60+ year data like the original gastric bypass.
Bile reflux and bile esophagitis is a associated symptom that can be unpleasant and can lead to cancer (rare).
Newer procedure lacking long term data on safety and efficacy. May be as effective gastric bypass, with less side effects than duodenal switch. American Society for Metabolic and Bariatric Surgery recommends cautious approach to its adoption.

Laparoscopic Roux-en-Y Gastric Bypass

The laparoscopic RY gastric bypass is performed by introducing a laparoscope, which is connected to a video camera, through small abdominal incisions, giving a magnified view of the internal organs on a television monitor. Learn more

Laparoscopic Vertical Sleeve Gastrectomy

Vertical sleeve gastrectomy, also known as parietal gastrectomy or just Sleeve gastrectomy consists of an operation that aims, if performed alone, to be restrictive in nature. Learn more