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Bariatric Procedures |
Endoscopic Treatment
(Temporary) |
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Surgical Treatment
(Permanent) |
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| 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).
No intestinal bypass performed. |
Small 1 ounce pouch
(20-30cc) connected to the small intestine.
Food and digestive
juices are separated for 3-5 feet. |
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| Mechanism |
Reduced stomach volume.
Induce satiety. |
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. |
Significantly restricts
the volume of food that can be consumed.
NO malabsorption
NO dumping |
Significantly restricts
the volume of food that can be consumed.
Mild malabsorption.
"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
Avoid liquid calories
Regular exercise
Remove in 6 months, able to maintain healthy dietary habit |
Small meal size
Avoid liquid calories
Regular exercise
Follow-up adjustment of band |
Small meal size
Avoid liquid calories
Regular exercise |
Small meal size
Avoid liquid calories & fatty food (dumping syndrome)
Regular medication (vitamin)
Regular exercise |
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| Advantage |
No surgery
Reversible |
Low risk surgery
Reversible
Adjustable |
Faster weight loss
No foreign material
No need adjustment |
More effective weight
loss
Better control in diabetes |
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| Disadvantage |
Possible weight rebound
after removal balloon (70%) |
Slow weight loss
Less effective in superobese & poor complicance patients
Presence of foreign material
Possible failure & require removal (10%) |
Irrevesible
Slightly higher risk surgery |
Ireverisble
High risk surgery
Need life-long medication
Risk of mal-nutrition |
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| Patient Choice |
Not accept / suitable
for surgery
Willing to reduce meal size
Can comply dietary advise |
Accept surgery (lowest
risk) & Presence of foreign implant
Willing to reduce meal size
Can comply dietary advise |
Accept surgery
(moderate risk)
Removal part of stomach
Willing to reduce meal size
Can comply dietary advise |
Accept surgical (higher
risk)
Control severe diabetes
Willing to reduce meal size
Can comply dietary advise |
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| Our recommendation |
Lower BMI (< 35
kg/m2)
High operative risk
Can use to loss weight before major surgery |
BMI < 50 kg/m2
More disciplined patients in dietary restriction & exercise
program |
BMI > 40 kg/m2
First stage procedure for superobese (BMI > 60)
Limited long-term result |
High BMI (> 50
kg/m2)
Diabete patients
Second stage procedure for revisional surgery |
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