Modality of Weight Loss	Restrictive and Malabsorptive (stomach and intestines)	Restrictive (stomach only)
Type of Operation	Roux-en-Y Gastric Bypass Surgery	Vertical Sleeve Gastrectomy	Lap Band Surgical Procedure
Anatomy	Small 1 ounce pouch (20-30cc) connected to the small intestine. Food and digestive juices are separated for 3-5 feet.	Long narrow vertical pouch measuring 2-3 oz (60-100cc). Identical to the duodenal switch pouch but smaller. No intestinal bypass performed.	An adjustable silicone ring (band) is placed around the top part of the stomach creating a small 1-2 ounce (15-30cc) pouch.

Mechanism	Significantly restricts the volume of food that can be consumed. Mild malabsorption "Dumping Syndrome" when sugar or fats are eaten	Significantly restricts the volume of food that can be consumed. NO malabsorption NO dumping	Moderately restricts the volume and type of foods able to be eaten. Only procedure that is adjustable Delays emptying of pouch Creates sensation of fullness
Weight Loss Average statistical loss at 10 years	70% loss of excess weight More failures (loss of <50% excess weight) than the DS	60%-70% excess weight loss at 2 years Long term results not available at this time.	60% excess weight loss. Requires the most effort of all procedures to be successful.
Long Term Dietary Modification (Excessive carbohydrate/high calorie intake will defeat all procedures)	Patients must consume less than 800 calories per day in the first 12-18 months; 1000-1200 thereafter?3 small high protein meals per day Must avoid sugar and fats to prevent "Dumping Syndrome" Vitamin deficiency/protein deficiency usually preventable with supplements	Must consume less than 600-800 calories per day for the first 24 months, 1000-1200 thereafter No dumping, no diarrhea Weight regain may be more likely than in other procedures if dietary modifications not adopted for life	Must consume less than 800 calories per day for 18-36 months, 1000-1200 thereafter. Certain foods can get "stuck" if eaten (rice, bread, dense meats, nuts, popcorn) causing pain and vomiting. No drinking with meals
Nutritional Supplements Needed (Lifetime)	Multivitamin Vitamin B12 Calcium Iron (menstruating women)	Multivitamin Calcium	Multivitamin Calcium
Potential Problems	Dumping syndrome Stricture Ulcers Bowel obstruction Anemia Vitamin/mineral deficiencies (Iron, Vitamin B12, folate) Leak	Nausea and vomiting Heartburn Inadequate weight loss Weight regain Additional procedure may be needed to obtain adequate weight loss Leak	Slow weight loss Slippage Erosion Infection Port problems Device malfunction
Hospital Stay	2-3 days	1-2 days	Overnight (<1 day)
Time off Work	2-3 weeks	1-2 weeks	1 week
Operating Time	2 hours	1.5 hours	1 hour
Recommendation	Most effective for patients with a BMI of 35-55 kg/m2 and those with a "sweet-tooth". Virtually all insurance companies will authorize this procedure.	Utilized for high risk or very heavy (BMI > 60 kg/m2) patients as a "first-stage" procedure. Very low complication rate due to quicker OR time and no intestinal bypass performed. Insurance companies will authorize this procedure in select patients.	Best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions. Many insurance companies will NOT authorize this procedure.