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Surgical Treatment Options

The primary purpose of bariatric surgery is weight loss.

Bariatric surgery is recommended for severely obese patients who have been unsuccessful with diet and exercise, medical treatment and pharmacotherapy, and have health concerns related to their obesity.

A systematic review published by the International Journal of Obesity reported that weight loss using pharmacotherapy and low-calorie diets resulted in a higher than expected percentage of fat-free mass loss.⁶³

Substantial and sustained weight loss is typical of surgical weight loss interventions. Fat-free mass loss is favorable after laparoscopic adjustable gastric banding (LAGB) surgery, indicating its safety and analogy to simple sustained caloric restriction.⁶³

Most bariatric surgeries are being performed laparoscopically and have been shown to be advantageous due to reductions in surgical morbidity, postoperative pain, length of hospital stay and recovery time.⁷

Currently, most bariatric procedures are being performed laparoscopically. This approach has the advantages of fewer wound complications, less postoperative pain, a shorter hospital stay, and more rapid postoperative recovery with comparable efficacy.^6,⁸

Surgical treatment options include:

	Laparoscopic Adjustable Gastric Banding (LAGB)	Roux-en-Y Gastric Bypass (RYGB)	Laparoscopic Sleeve Gastrectomy
	View Placement Animation View Adjustments Animation These animations require Quicktime	View Animation These animation requires Quicktime
Procedure	No change in the anatomy or stomach stapling is required Regular follow-ups allow for optimal results	Requires cutting and stapling of stomach and bowel	Requires cutting and stapling of stomach
Short-term (1 year) excess weight loss	47.5% excess weight loss at 48 weeks*^†107	67% average excess weight loss 52 weeks after surgery¹¹	46% to 83% excess weight loss 1 year after surgery⁷⁰
Long-term (>5 years) excess weight loss	55% average excess weight loss 5 years^†11	58% average excess weight loss 5 years after surgery¹¹	No follow-up reported >3 years⁷⁰ May require second surgery
Postsurgical mortality (short-term)	0.05%⁷¹	0.50%⁷¹	0.39%⁷⁰
Early Complications	1.0%¹⁰²	4.8% within 30 days (laparoscopic RYGB)¹⁰² 7.8% within 30 days (open RYGB)¹⁰²	2.9%⁷⁴
Postsurgical complications (long-term) include	Band slippage^†75 Stoma obstruction^†75 Gastroesophageal reflux^†75 Nausea and vomiting^†75 Erosion^†75	Hernia⁷³ Marginal ulcer⁷³ Bowel obstruction⁷³ Iron, vitamin B12, folic acid, and calcium deficiencies⁷⁶ Dumping syndrome⁷¹	Gastric remnant dilatation⁷⁷ Suture line bleeding and leakage⁷⁷ Gastric strictures⁷⁷ May require second surgery⁷⁷
Adjustability	Adjustable Reversible	Nonadjustable Permanent	Nonadjustable Permanent May require second surgery, doubling the risks associated with surgery and anesthesia

*Data based on on interim analysis of ongoing LAP-BAND AP^® trial.

† The LAP-BAND AP^® System was approved in the United States on the basis of a non-randomized, single-arm study (N=299). Significant improvement in percent of excess weight loss vs. baseline was achieved at 12 months (34.5%), 24 months (37.8%), and 36 months (36.2%) with some complications reported.

Click here for more detail information on postsurgical complications with the LAP-BAND^®.

Reference

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Reference

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Surgical Treatment Options

Surgical treatment options include: