The three most commonly performed procedures in Australia and in some other countries include laparoscopic adjustable gastric banding (LAGB) or lap band, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). All of these can be done laparoscopically or what is called keyhole surgery, which means with multiple small incisions about 1cm long and cameras and fine instruments, so there are no major scars.
- Roux-en-Y gastric bypass is when the surgeon begins by creating a small pouch by dividing the upper end of the stomach. This restricts the food intake. Next, a section of the small intestine is attached to the pouch to allow food to bypass the end of the stomach and first part of the small intestine. The small intestine is re-connected from the pouch to allow ingested food and digestive enzymes to mix. I have put links to videos on this below if you want to see how it works. On average the hospital stay for patients who undergo the Roux-en-Y gastric bypass is usually two to four days and if needed it is potentially reversible.
- With laparoscopic adjustable gastric banding or lap banding, the surgeons implant an inflatable silicone band around the upper portion of the stomach so the band creates a new, tiny pouch that limits and controls the amount of food consumed because people feel full with much less food. There are a few pros to this choice, it is often reversible, minimal scars as it is keyhole surgery, no cuts to the stomach and a shorter hospital stay of 1-2 days. The problems with these are there a range of other complications that can happen with the band in particular slipping of the band or irritating the stomach. These can occur in up to ⅓ patients. Also, there are higher failure rates than initially thought, such that only 54% of people who get one keep it in after 10 years.
- And finally the sleeve gastrectomy. This is basically where they remove about 75% of the stomach. With little stomach, you can’t eat much food and you lose weight, pretty simple. It is often also keyhole surgery. As you can imagine, this is not reversible.