Type of Procedure	Adjustable gastric banding (LapBand)	Roux-en-Y Gastric bypass	Sleeve gastrectomy	Bilio-pancreatic diversion with duodenal switch
Anatomy	An adjustable silicone ring (band) is placed around the upper part of the stomach creating a small (15-30cc) pouch.	A small stomach pouch (20-30cc) is connected to the small intestine. Food and digestive juices are separated for 1 1.5metres (approx 3-5 feet).	Creation of a long narrow vertical stomach pouch (50-100cc) by removing of the stomach. Identical to the duodenal switch pouch but smaller. There is no intestinal bypass performed.	A long vertical stomach pouch measuring about 120-150cc is created. The duodenum (first portion of the small intestine) is connected to the last 2 - 2.5 metres or 6 feet of small intestine. Food and digestive fluids are separated for more than 12 feet and only mix in the last one metre or approx 3 feet of small intestine.
Mechanism	Works by moderately restricting the volume and type of foods able to be eaten. Delays emptying of pouch Only procedure that is adjustable Creates longer sensation of fullness	Significantly restricts the volume of food that can be consumed. Mild malabsorption "Dumping Syndrome" when sugar or fats are eaten	Significantly restricts the volume of food that can be consumed. Causes no malabsorption Causes no dumping	Restricts the volume of food that can be consumed to a moderate degree. Causes some malabsorption of fat causing diarrhea and bloating
Weight Loss(variable based on individual circumstances, motivation and mobility)	Approx. 50% excess weight loss. Requires the most effort compared to other weight loss procedures to be successful.	70% loss of excess weight most weight loss occurring in the first 12 months after surgery.	60%-70% excess weight loss at 2 years The long term results of sleeve gastrectomy is still unknown.	80 - 90% loss of excess weight Some patients may lose too much weight or develop nutritional problems than the Roux-en-Y gastric bypass.
Long Term Dietary Modification(Excessive carbohydrate/high calorie intake will defeat all procedures)	Must stick to healthy diet lifelong. Certain foods can get "stuck" if eaten causing pain and vomiting. Such diet may include bread, some nuts but our team dietician would be able to advise you accordingly after your surgery No drinking with meals	Must avoid sugar and fats to prevent "Dumping Syndrome" Vitamin deficiency/protein deficiency usually preventable with supplements	No dumping, no diarrhea Weight regain may be more likely than in other procedures if dietary modifications not adopted for life	Consumption of fatty foods causes diarrhea and malodorous gas/stool Failure to strictly adhere to the required vitamin supplements and consumption of high protein meals will more likely to result in deficiency than Roux-en-Y gastric bypass.
Nutritional Supplements Needed (Lifelong)	Not always necessary but multivitamins and calcium may be taken regularly	Multivitamin Vitamin B12 Calcium Iron (menstruating women)	Vitamin B12 Calcium	Multivitamin ADEK vitamins Calcium Iron (menstruating women)
Potential Problems	Slower weight loss Slippage Erosion Infection Access port/tube problems Band malfunction	Dumping syndrome Stricture Ulcers Bowel obstruction Anaemia Vitamin/mineral deficiencies (Iron, Vitamin B12, folate) Anastomotic leak	Nausea and vomiting Heartburn Inadequate weight loss Weight regain Additional procedure may be needed to obtain adequate weight loss Leak	Nausea and vomiting Heartburn Severe diarrhea Kidney stones Stricture Ulcers (less than RNY) Bowel obstruction Nutritional/Vitamin deficiencies (Vitamin A,D,E,K)?Loss of too much weight requiring reoperation Leak
Hospital Stay	Overnight (<1 day)	2-3 days	1-2 days	3-4 days
Time off Work	2 weeks	2-3 weeks	2 weeks	2-3 weeks
Recommendation	Best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions.	Most effective for patients with a BMI of 40 kg/m2 and above especially those with multiple obesity-related health problems such as diabetes, hypertension and sleep apnoea.	Often performed in high risk or very heavy (BMI > 60 kg/m2) patients as a first step procedure followed by a more definitive procedure such as Roux-en-Y gastric bypass but increasingly being used on its own in some cases.	May be suitable for patients with a BMI of > 60 kg/m2. Higher overall incidence of complications than other procedures.