Comparison of bariatric procedures
| Measure | LAGB | VBG | SG | JIB | BPD | BPD with or without DS | RYGB |
|---|---|---|---|---|---|---|---|
| Mechanism of action | Restriction | Restriction | Restriction | Malabsorption > restriction | Malabsorption > restriction | Malabsorption > restriction | Restriction > malabsorption |
| Procedure | Involves placing an adjustable plastic and silicone ring around the stomach below the gastroesophageal junction. A subcutaneous access port allows adjustment of the band by injection or withdrawal of saline. | Involves partitioning the stomach using surgical staples to create a vertical pouch and horizontal segment at the top edge of the stomach. A polypropylene band is used around the lower end of the vertical pouch to prevent stretching. (21) | Involves dividing the greater curve of the stomach, starting 6 cm proximal to the pylorus and continuing to the angle of His, by stapling it over a sizing tube ranging from 32 F to 48 F. (24) | Involves bypassing a majority of small intestine by anastomosing the proximal jejunum, past the ligament of Trietz, to the terminal ileum, leaving a blind jejunal-ileal limb. | Involves forming a gastric pouch (horizontal gastrectomy) anastomosed to the distal 250 cm of small intestine (Roux limb). The biliary limb is connected to the Roux limb 50 cm proximal to the iliocecal valve. (21) | Modification of BPD. Involves creating an SG and dividing the small bowl 4– 5 cm distal to the pylorus and 250 cm proximal to the terminal ileum. The proximal duodenum/stomach is connected to the distal 250 cm of small intestine, and the biliary limb is connected to the Roux limb 100 cm from the iliocecal valve. (33) | Involves creating a small, vertically oriented gastric pouch (~30 mL) that is connected to a Roux limb formed by division of the jejunum about 40–60 cm from the ligament of Trietz. The biliary limb is reconnected to the Roux limb 150 cm from the gastrojejunostomy. (21) |
| Excess weight loss | 47.5% 2 yr postop (19) | 68.2% 2 yr postop (19) | 33%–83% 1 yr postop (106), (107) | 34%–36% 2 yr postop (31), (32) | 63.2%–77.8% 10 yr postop (108) | 74% (33) | 61.6% (19) |
| Early complications ≤ 30 d postop | Gastric or esophageal perforation, port/wound infection, stoma obstruction, hemorrhage (109) | Staple line leak, stenosis, ulcer, wound infection, staple line disruption, pouch dilation and band erosion (21) | Staple line leak, abscess, bleeding, stricture, wound infection, splenic injury (107) | Diarrhea, electrolyte abnormalities (B12, folate) (110) | Wound infection, dehiscence, anastomotic leak (21), (111) | Gastric staple line leak (33) | Anastomotic leaks, bowel obstruction, bleeding, wound infection, deep vein thrombosis/pulmonary embolism (21) |
| Late complications > 30 d postop | Band slippage, access-port infection, port and tubing problems, band erosion (109) | 30% revision rate, anastomotic stricture, incisional hernia, marginal ulcer, nutritional deficiencies, bowel obstruction (21) | Staple line leak, stricture, choledocholithiasis and bile duct stricture (112) | Diarrhea, electrolyte abnormality, nephrolithiasis, cholecystitis, cirrhosis (110) | Incisional hernia, protein malnutrition, gastric ulcer, hypoalbuminaemia, anemia (21), (111) | Protein malnutrition, incisional hernia (33) | Anastomotic stricture, bowel obstruction, incisional hernia, marginal ulceration, nutritional deficiencies (21) |
| Mortality < 30 d:> 30 d | 0.06%:0% (35) | 0.21%:0% (35) | 0.46%:0.15 (113) | 0.9%:3%–4% (31), (32) | 1.3%:NA (111) | 1.11%:NA (35) | 0.16%:0.09% (35) |
BPD = biliopancreatic diversion; DS = duodenal switch; JIB = jejunal-ileal bypass; LAGB = laparoscopic adjustable gastric band; NA = not available; postop = postoperatively; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; VBG = vertical-banded gastroplasty.