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There are several options available to those individuals who seek therapy for treatment of severe obesity, each one having its advantages and its disadvantages. Generally speaking, weight loss can be accomplished, but each patient should consider operative risks, including the possibility of death and the possibility of other side effects, before committing to surgery. In most cases, bariatric surgeries can be and are carried out safely. Procedures can be grouped into three main categories:

1. Predominantly malabsorptive procedures-while reducing stomach size, these procedures are based mainly on malabsorption. Example: Biliopancreatic Diversion
2. Predominantly restrictive procedures-this type of procedure is used to primarily reduce stomach size. Examples: Vertical Banded Gastroplasty, “Lap Band,” and Sleeve Gastrectomy
3. Mixed Procedures- these procedures apply both techniques simultaneously. Examples: Gastric Bypass and Sleeve Gastrectomy with Duodenal Switch

Biliopancreatic Diversion

This complex procedure (abbr. BPD), also referred to as Scopinaro Procedure, was once used often but is now rare do to problems with malnourishment in patients who received the surgery. It has been replaced with the Duodenal Switch (BPD/DS). In this procedure part of the stomach is resected to create a smaller stomach (this is the restrictive part). The distal part of the small intestine is then connected to the pouch bypassing the duodenum and jejunum. This process results in severe malabsorption and, eventually, nutritional deficiency.

The malabsorption effect of this surgery is so potent that patients who undergo the procedure must take nutritional supplements in significantly larger doses than the general population in order to avoid suffering side effects such as malnutrition, anemia, and osteoporosis.

Gallstones are a common complication with this procedure and because of this many surgeons will remove the gallbladder during the BPD procedure as a preventative measure. Other surgeons prefer the use of medication to reduce the risk of this particular complication after the surgery. Due to the high risk of such side effects, very few surgeons perform BPD in comparison to other weight loss surgeries. The need for long-term nutritional follow-up and monitoring of BPD surgical patients also deters many surgeons away from recommending or performing BPD procedures.

Vertical Banded Gastroplasty and Adjustable Gastric Banding

In the Vertical Banded Gastroplasty procedure, a portion of the stomach is stapled in order to create a smaller, pre-stomach pouch, which will serve as a new, functioning stomach. The same result can be reached by use of a silicone band, which patients can adjust themselves in accordance with their individual needs and desires. The latter procedure is generally referred to as “Lap Band” surgery when promoted or advertised amongst the general public.

The year 1985 was when the first gastric band was patented by Obtech Medical of Sweden, now owned by J&J/Ethicon and known as the Swedish Adjustable Gastric Band (SAGB). INAMED Health, an American company, later designed the BioEnterics LAP-BAND Adjustable Gastric Banding System. This system was introduced in Europe initially in 1993 and received Food and Drug Administration (FDA) approval in the United States in June of 2001. The first lower-pressure, wider, one-piece adjustable band was designed during the year 2000 and was called the MIDband and was placed in Lyon France Medical Innovation Development. Unlike early bands, the MIDband was designed specifically for laparoscopic insertion and it quickly became one of the most popular bands in France.

Sleeve Gastrectomy with Duodenal Switch

This surgical procedure is a variation of the BPD method that includes a duodenal switch. Part of the stomach on its greater curve is resected and the stomach is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the upper part of the small intestine are reattached to the rest at about 75-100 centimeters from the colon.

Gastric Bypass Surgery

The most common type of Gastric Bypass procedure is called Roux-en-Y gastric bypass surgery. In this procedure a small stomach pouch is created with a stapling device and is then connected to the distal small intestine. At this point the upper part of the small intestine is reattached in a Y-shaped configuration.

In the United States, gastric bypass is the most common type of bariatric surgery performed on overweight and obese patients. Approximately 14,000 gastric bypass procedures were performed during 2005, dwarfing the number of Lap-Band, duodenal switch, and vertical banded gastroplasty surgeries that were performed. Since gastric bypass has been used for the treatment of obesity for nearly 50 years, the medical community has become very comfortable with the understanding of the risks and benefits that are associated with this particular surgery. The sheer volume of gastric bypass cases in addition to the scientific research on the subject have become the “gold standard” operation for weight loss in the United States. An emerging factor in the success of gastric bypass surgery is following a specific gastric bypass diet following the surgical procedure.