Advantages, Disadvantages, Risks

Each of the weight-loss surgeries has advantages and disadvantages that you'll want to consider with your doctor.

Restrictive Surgery

Sleeve Gastrectomy

Advantages: You can expect to lose excess body weight at about the same rate and percent as the Gastric Bypass or on average 77% of excess body weight at one year to 18 months. You can see resolution of co-morbidities such as diabetes, high blood pressure, etc.  It does not involve placing any foreign material in the body and has no risks of malabsorption.

The Vertical Gastrectomy procedure is sometimes used as the first stage for those individuals who are too large to undergo a normal weight loss surgery.  Usually, the weight limit for weight loss surgery is around 425 pounds.  These patients can have the vertical gastrectomy, and if further surgery is needed after achieving the weight loss from the procedure, it can be performed more safely.

Disadvantages: You may experience nausea and vomiting if you overeat, which can result in pain and/or stretching of the stomach.

Lap Band

Advantages: Once the Lap Band is in place, it can be adjusted to increase or decrease restriction.  In the event that you need additional nutrients, the band can be adjusted and you can eat a greater amount of food.  Additionally, this surgical procedure can be reversed, if necessary.

Disadvantages: Lap Band patients can expect to lose an average of 37 percent excess body weight in the first year, which is the least amount of weight loss for any of the surgical procedures. In addition, to keep the weight off, you will need to change your eating habits, stick to a long-term plan of healthy eating, and engage in regular physical activity. If you start to eat high-calorie soft foods (such as ice cream or milk shakes) that easily pass through the pouch opening to the stomach, you'll gain weight.

Risks: The most common risk is vomiting.  This happens if you eat too much at once and the narrow passage into the larger part of your stomach gets blocked. Another risk arises if the gastric bands slips or wears into the stomach the port or tubing of the band can get infected.

Combined Restrictive/Malabsorptive Surgery

Advantages: You're more likely to lose weight quicker than with the Lap Band surgery, and you'll continue to lose weight for 18 to 24 months after the procedure.  With the Roux-en-Y, you're likely to maintain a weight loss of 60 to 70 percent of your excess weight for years.  With BDP, you'll lose roughly 70 to 80 percent of your excess weight.  Because combined operations result in greater weight loss than the Lap Band, they may also be more effective in improving health problems you may have associated with severe obesity, such as high blood pressure, sleep apnea, type-2 diabetes, and osteoarthritis.

Disadvantages: Combined procedures are somewhat more difficult to perform than restrictive procedures.  They are also more likely to result in long-term nutritional deficiencies.  For instance, you will not absorb enough iron and calcium. (Menstruating women may develop anemia because not enough Vitamin B12 and iron are absorbed).  Your decreased absorption of calcium may also bring on osteoporosis and related bone diseases.  You must take nutritional supplements to help prevent the deficiencies.  If you have the biliopancreatic diversion procedure, you will need to take fat-soluble vitamins A, D, E and K supplements.  You may require life-long use of special foods and medications.

Roux-en-Y and Biliopancreatic Diversion operations may also cause "dumping syndrome," an unpleasant reaction after you eat a meal high in simple carbohydrates (which contain sugars that are rapidly absorbed by the body).  The dumping syndrome occurs when the contents in your stomach move too quickly through the small intestine.  You may experience nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea after eating.

Risks: In addition to risks associated with restrictive procedures (such as infection), combined operations are more likely to lead to complications.  You'll be at greater risk for abdominal hernia (up to 28 percent), which may require follow-up surgery to correct.  Your risk of hernia, however, is reduced to less than 3 percent when laparoscopic techniques are used.  And, as with restrictive surgery, there is also a risk of death.  However, that risk is lower for the Roux-en-Y gastric bypass (less than 1 percent of patients) than for the Duodenal Switch (2.5 to 5 percent).