Types of surgery

The type of surgical procedure done is also an important factor to consider.
Laparoscopic adjustable gastric banding (LAGB) is a restrictive, but not
malabsorptive procedure. Laparoscopic Roux-en-Y gastric bypass (RYGB) is
both a restrictive and malabsorptive procedure. Newer on the playing field,
laparoscopic sleeve gastrectomy (LSG), is also promoted as a restrictive
procedure without malabsorption effects.
Roux-en-Y gastric bypass. Roux-en-Y gastric bypass (RYGB) surgery has the
advantage of established long-term efficacy for weight loss and reductions
of obesity-related comorbities (i.e., type 2 diabetes mellitus, lipid
abnormalities, and hypertension). It is relatively safe, and weight loss
results are reported typically as a loss of 60 to 80 percent of excess body
weight (EBW). It combines elements of restrictive, hormonal, and
malabsorptive procedures. Maximum weight loss with RYGB is usually
achieved by 12 to 18 months following surgery.

Laparoscopic adjustable gastric banding. Laparoscopic adjustable gastric
banding (LAGB) has been around for a number of years in other countries. It
was approved for use in the United States in 2001. It is strictly a
restrictive procedure. Weight loss is generally slower than gastric bypass
(an average of 2 pounds per week) and yields a decrease of approximately 44
to 68 percent of EBW at four years. Adjustments of the band require more
office visits after surgery (around 10 in the first year) and an annual
upper gastrointestinal test. Band slippage is a risk that can be serious
and may even require a second surgery for gastrectomy or conversion to RYGB.
The gastric banding option for kidney transplant patients is questionable
due to the presumed predisposition to infection presented by a foreign body
(i.e., the band) in immunosuppressed patients after transplant.