Detailed Comparison of Our Procedures
| Laparoscopic Gastric Bypass | Laparoscopic Sleeve Gastrectomy | |||||||||||||||||||||||||||||||||||||
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| 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 Ghrelin production 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 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 “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 fewer 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 B 12 Calcium Iron (menstruating women) | Multivitamin Calcium | ||||||||||||||||||||||||||||||||||||
| What are the chances I might die from this surgery and are there any other immediate risks? |
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| What are the long term risks from this surgery? |
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| 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. | ||||||||||||||||||||||||||||||||||||
| Our Recommendation | 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/m 2 (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! | ||||||||||||||||||||||||||||||||||||
This table below is best viewed on desktop
| Roux-en-Y Gastric Bypass | Vertical Sleeve Gastrectomy | Duodenal Switch | One Anastomosis Gastric Bypass | Single Anastomosis Duodenal Ileostomy | |
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| World wide 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 |
| Is the surgery reversible? | YES | NO | NO | YES | NO |
| Does the procedure eliminate hunger? | YES | YES | YES | YES | YES |
| Chance of dying within 30 days of surgery | 0 – 0.5% | 0 – 0.5% | 0 – 1.6% | 0 – 0.5% | Unknown as yet |
| Average weight loss 10 years after surgery | 70% of excess weight | 55% of excess weight | 75% of excess weight | Unknown as yet | Unknown as yet |
| How fast will I reach my maximum weight loss? | 18 months | 2 years | 18 months | 18 months | 18 months |
| Can I regain weight after this procedure? | + | ++ | + | ++ | Unknown as yet |
| Type-2 Diabetes control | +++ | ++ | ++++ | ++ | Unknown as yet |
| High Blood Pressure control | +++ | ++ | +++ | ++ | Unknown as yet |
| Lipid & Cholesterol control | +++ | ++ | ++++ | + | Unknown as yet |
| Sleep Apnea control | +++ | ++ | +++ | + | Unknown as yet |
| Life-Long 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 |
| Dr. Christou’s Recommendations | Recommended for patients with a BMI of >40 kg/m
2.
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/m
2 (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.
This is our second most popular procedure. |
Best for patients with BMI>60 kg/m
2 who accept certain inconveniences like frequent bowel movements, flatulence
etc.
Dr. Christou’s main reservation is the need for rigid adherence to diet supplements which most patients fail to follow long term. |
Recommended for patients with a BMI of >40 kg/m
2.
Bile reflux and bile esophagitis (an irritation of the tube connecting the stomach and mouth from bile coming up the single anastomosis to the pouch and the esophagus) can lead to cancer (rare). |
Not enough experience available world-wide to make recommendation.The American Society of Metabolic and Bariatric Surgery position statement is that SADI is an experimental procedure and requires further study. |
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