In Vogue:
Gastroplication
Gastric banding (laparoscopic)
Laparoscopic Vertical Banded Gastroplasty (VBG)
Laparoscopic Adjustable Silicone gastric Band (ASGB)

Gastric bypass
Biliopancreatic diversion
Biliopancreatic diversion  with duodenal switch


Gastric Stapling / Gastroplication
Started in the 1980s
Reduces stomach size to 50 mls
Cholecystectomy performed simultaneously
Fallen out of favour despite modifications


Laparoscopically adjustable silicone gastric band (ASGB)
715 patients
Mean BMI 43.1 kg/m2
Mean operative time 78 min
Post-op hospitalization time 1.2 days
At 2 years:
Average BMI dropped from 43.3   to   32.1 kg/m2
8% patients required reoperations
Surg Endosc. 2002 Feb;16(2):230-3. Epub 2001 Oct 05.

Laparoscopic vertical banded gastroplasty (VBG) 

250 patients
Operative time 95 minutes
At 4 years:
    Morbidly obese patients achieved BMI of 29
    Half of patients BMI >50 achieved BMI 35
    Re-operation rate 2%

Surg Endosc. 2002 Nov;16(11):1566-72. Epub 2002 Jun 14

Gastric Bypass
Most effective treatment
Only recommended for morbid obesity
Up to 30% weight loss attainable
Patients may even come off insulin totally
Up to 3% improvement in glycated Hb.
Takes 168 mts, 196 mts, 210 mts
The mortality rate for gastric bypass surgery averages around 1%
 
Biliopancreatic diversion (BPD)
Complicated malabsorptive operation,
Portions of the stomach are removed
The small pouch is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum.
Less frequently used
High risk for nutritional deficiencies.
 
BPD with Duodenal switch
A variation of BPD
 
Duodeno-ileostomy + Jejuno-ileostomy

This keeps a small part of the duodenum in the digestive pathway and thus leaves a larger portion of the stomach intact, including the
pyloric valve that regulates the release of stomach contents into the small intestine.

Laparoscopic bypass Vs Open gastric bypass
52 patients totally

     LGB
          Fewer ITU admissions
          Shorter hospital stay
 
     OGB
          Resulted in better reversal of obesity complications
 
Am Surg. 2003 Jul;69(7):547-53; discussion 553-4

Ann Surg. 1995 Sep;222(3):339-50; discussion 350-2

Post surgery improvements in obesity co- morbidity

 Weight loss starts soon after surgery and continues for 2 years
 Diabetes mellitus resolves in 85% to 90%
 Hypertension resolves in 66% to 75%
 Urinary incontinence resolves in 95% of patients.
 Acid reflux disappears in most patients
 Sleep apnoea resolves or improves
 Fertility is restored in many

Surg Endosc. 2002 Feb;16(2):230-3. Epub 2001 Oct 05

Bypass procedures are associated with greater risk reductions than restrictive procedures, probably related to the greater degrees of
weight loss produced by this method. Ann Surg. 2004 Sep;240(3):416-23. The alterations in gut hormone profiles produced by the greater
weight loss might also be a factor through improvement of hyperinsulinism, as insulin may well have atherogenic and carcinogenic
potential.
Read more on bariatric surgery and gut hormone changes

Recurrence of obesity after surgery

      The Swedish Obesity Study found recurrence of hypertension with weight regain at 7 years after surgery  (banding)
       (not seen in the gastric bypass surgery studies )

        Swedish Obesity Study (SOS)- Surgical Banding
              Improvements in  Diabetes mellitus (47%) and hypertension (42%)
              (less than in the American studies)

              23% of body weight lost in the SOS (using mostly gastroplasty and banding procedures)
              (less than with gastric bypass  which produces up to 35% of body weight loss)

Read an overview of bariatric surgery at the American Bariatric Surgery Society

Read the Cochrane analysis of bariatric surgery for morbid obesity

The full NICE guidance on the use of bariatric surgery in morbid obesity is available here  (PDF format).
 if you do not have adobe acrobat reader, download the latest version here

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    This page was last updated on: 07/03/2007

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