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 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?
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 2006-2017 with no surgical mortality in over 1,400 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
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 – 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/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!
Show comparisons of other procedures
 

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
Graphic Representation Gastric Bypass Realize ENG VSG Realize ENG PPDDS_ENG_REALIZE OAGB SADI
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 (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

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