11
Bariatric
Surgical
Procedures
Pros
Cons
Expected
Excess
Body
weight
Loss
(EBWL)
at
2
Years
Optimally Suited
for
Patients
With:
Other
Comments
Roux-en-Y Gastric
Bypass
Greater
improvement
in
metabolic
disease
and
gastro-
esophageal
reflux
disease
(GERD)
Increased
risk
of
malabsorptive complications over
sleeve
60–75%
Higher
BMI,
GERD,
Type
2
diabetes
mellitus
(DM)
Largest
data
set
Vertical
Sleeve
Gastrectomy (VSG)
Improves
metabolic
disease;
micronutrient
deficiencies inf
requent
Can
worsen
GERD
and
Barrett's
esophagus
50–70% (3-year
data
a
)
Metabolic
disease
Currently most
common
procedure performed
Laparoscopic Adjustable Gastric
Banding
(LAGB)
Least
invasive;
removable
Limited
efficacy
and
any
metabolic
benefits
achieved
are
dependent
on
weight
loss
30–50%
Lower
BMI;
no
metabolic
disease
Performance has
declined
and
removal
rate
of
at
least
25
percent
at
five
years
Biliopancreatic Diversion
with
Duodenal Switch (BPD/DS)
Greatest
amount
of
weight
loss
and
resolution
of
metabolic
disease
Increased
risk
macro-
and
micronutrient deficiencies
over
bypass
70–80%
Higher
BMI,
Type
2
DM
Most
technically
challenging
Loop
Duodenal
Switch
May
be
simpler
and
safer
than
BD-DS
with
less
micronutrient
deficiencies
Long-term
data
not
available
70–80%
Higher
BMI,
Type
2
DM
Two
step
procedure:
VSG
followed
by
single
anastomosis
a
Excess
body
weight
(EBW)
=
(total
body
weight)
–
(lean
body
weight)
