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Bariatric Procedures |
Endoscopic Treatment
(Temporary) |
|
Surgical Treatment
(Permanent) |
|
Type of Procedure |
Intragastric Balloon |
Laparoscopic Adjustable Gastric Banding |
Laparoscopic Sleeve Gastrectomy |
Laparoscopic Gastric Bypass |
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Anatomy |
A 500cc balloon is
inserted through the month into stomach. |
An adjustable silicone
right (band) is placed around the top part of the stomach creating a
small 1-2 ounce (15-30cc) pouch. |
Long narrow vertical
pouch measuring 2-3oz (60-100cc).
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No intestinal bypass performed. |
Small 1 ounce pouch
(20-30cc) connected to the small intestine.
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Food and digestive
juices are separated for 3-5 feet. |
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Mechanism |
Reduced stomach volume.
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Induce satiety. |
Moderately restricts
the volume and type of foods able to be eaten.
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Only procedure that is adjustable. Delays emptying of pouch.
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Creates sensation of fullness. |
Significantly restricts
the volume of food that can be consumed.
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NO malabsorption
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NO dumping |
Significantly restricts
the volume of food that can be consumed.
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Mild malabsorption.
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"Dumping Syndrome" when sugar or fats are eaten. |
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Procedure time |
30 min |
60 - 90 min |
60 - 90 min |
120 - 180 min |
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Average Hospital stay |
0 - 1 day |
2 - 3 days |
4 - 6 days |
7 - 9 days |
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Average weight loss |
loss 10 - 12 kg in 6
months
(BMI ~5 kg/m2 loss) |
loss 20 - 30 kg in 2
years
(BMI ~10 kg/m2 loss) |
loss 25 - 35 kg in 2
years
(BMI ~12 kg/m2 loss) |
loss 30 - 40 kg in 2
years
(BMI ~15 kg/m2 loss) |
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Behavioral
Adjustment |
Small meal size
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Avoid liquid calories
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Regular exercise
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Remove in 6 months, able to maintain healthy dietary habit |
Small meal size
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Avoid liquid calories
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Regular exercise
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Follow-up adjustment of band |
Small meal size
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Avoid liquid calories
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Regular exercise |
Small meal size
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Avoid liquid calories & fatty food (dumping syndrome)
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Regular medication (vitamin)
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Regular exercise |
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Advantage |
No surgery
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Reversible |
Low risk surgery
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Reversible
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Adjustable |
Faster weight loss
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No foreign material
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No need adjustment |
More effective weight
loss
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Better control in diabetes |
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Disadvantage |
Possible weight rebound
after removal balloon (70%) |
Slow weight loss
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Less effective in superobese & poor complicance patients
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Presence of foreign material
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Possible failure & require removal (10%) |
Irrevesible
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Slightly higher risk surgery |
Ireverisble
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High risk surgery
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Need life-long medication
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Risk of mal-nutrition |
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Patient Choice |
Not accept / suitable
for surgery
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Willing to reduce meal size
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Can comply dietary advise |
Accept surgery (lowest
risk) & Presence of foreign implant
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Willing to reduce meal size
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Can comply dietary advise |
Accept surgery
(moderate risk)
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Removal part of stomach
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Willing to reduce meal size
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Can comply dietary advise |
Accept surgical (higher
risk)
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Control severe diabetes
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Willing to reduce meal size
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Can comply dietary advise |
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Our recommendation |
Lower BMI (< 35
kg/m2)
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High operative risk
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Can use to loss weight before major surgery |
BMI < 50 kg/m2
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More disciplined patients in dietary restriction & exercise
program |
BMI > 40 kg/m2
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First stage procedure for superobese (BMI > 60)
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Limited long-term result |
High BMI (> 50
kg/m2)
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Diabete patients
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Second stage procedure for revisional surgery |
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