Surgical procedures to treat obesity can be classified as malabsorptive or restrictive.  Malabsorptive procedures include the jejuno-ileal bypass and the biliopancreatic diversion/duodenal switch.  The jejuno-ileal bypass has largely been abandoned due to the development of structural liver abnormalities in one-third of patients and clinical cirrhosis in as many as 10%. In the BPD/DS, bile and pancreatic juices draining into the duodenum are diverted to the terminal ileum by a long Roux-en-Y limb, in addition to gastric partitioning. Excellent weight loss results; however, the procedure is not used widely because of the greater nutritional and metabolic risks. 

Restrictive procedures include the vertical banded gastroplasty (VBG) and gastric banding (i.e., Lap-Band®). Both procedures involve creating a small pouch in the stomach, 15 to 30 ml, to limit the amount of food a patient can eat. The Roux-en-Y gastric bypass (RYGB) also involves the creation of a small gastric pouch which is drained by the small intestine. This operation combines gastric restriction with a minimal degree of malabsorption. An added benefit is the limitation on the intake of simple sugars, which cause you to feel ill. Although the Lap-Band procedure has gained popularity since it was approved by the FDA in 2001, the RYGB is still the most commonly performed obesity procedure in the United States.

Dr. David Provost has experience with a variety of bariatric procedures, but prefers the RYGB and the Lap-Band. Both procedures are generally performed laparoscopically in most patients. This means that instead of performing the surgery through a standard incision, typically going from below the breastbone to above the umbilicus, the operation is done through six smaller incisions, less than one inch in length, using cameras and long instruments. More information about the Lap-Band and gastric bypass procedures is available on this site.