Which procedure do you consider the most advantageous and why?

Question
I am going through the steps to have bariatric surgery ( attending classes, consultation, etc ). Which procedure do you cpnsider the most advantageous and why? If done laproscopically, is there one that is safer than the others?          Thank you.

Answer
Mary Ann,
Realistically, you will only be able to get a complete answer to your question once you sit down with your chosen bariatric surgeon and he/she has a chance to review your medical history.  

There are three bariatric surgical procedures commonly performed in the U.S.:
-Roux-en-Y Gastric Bypass (usually called "gastric bypass")
-Vertical Sleeve Gastrectomy (usually called "sleeve")
-Adjustable Gastric Band (usually called "Lap-Band" or "Band")

Most surgeons (including myself) are becoming steadily less enthusiastic about the Band.  Although it has fairly low impact around the time of surgery, it turns out to require lots of maintenance over time, and the medium/long term success rate is not nearly as good as for the gastric bypass.

The sleeve is the newest of these operations, and many patients find it appealing because it does not involve post-operative adjustments (advantage in comparison to Band) and it does not involve re-routing the intestine (advantage in comparison to gastric bypass).  Weight loss results and health improvement are somewhat less than gastric bypass on average, but still significant and favorable.  Cautionary notes for the sleeve include the fact that it is a serious major operation that includes removal of most of the stomach, and the fact that it is relatively new so it has not been proven to last for decades.

The gastric bypass is the operation that has been around since the early 1980's.  Of these three operations, it is the one that has the best long term weight loss and the most positive metabolic impact.  Some patients are put off by the re-routing of the intestines that is done at the time of surgery, which leads to a small lifetime chance of bowel obstruction.


The three operations above are almost always performed laparoscopically, unless the patient has very unusual medical circumstances.

I did not discuss the Biliopancreatic Diversion with Duodenal Switch (BPD-DS), because it is not as widely accepted and because I do not perform that operation.

You may wish to look at the procedure comparison page on my website for more information:
http://www.ndwls.com/weight-loss-programs/weight-loss-surgery/compare-surgeries/

Best of luck,
Dr JP

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