types of surgeries
There are essentially two main components to the surgery offered to you; a restrictive procedure and a malabsorptive procedure or combination of both.
The purely restrictive procedures include adjustable gastric banding (AGB), gastric sleeve (GS) and vertical banded gastroplasty (VGB), the last of which is becoming obsolete due to its poor longterm success and unacceptable complication rates.
A gastric Roux-en-Y bypass procedure (Gastric Bypass) is predominantly restrictive procedure with a longer Roux limb (> 150cm) adding to the procedure a malabsorptive component. The better long term success achieved by the GBP over the purely restrictive operations is largely due to the hormonal changes that occur in the bypassed stomach and duodenum that in turn regulate the appetite and satiety centers of the brain.
Malabsorptive procedures lead to the best longterm outcome results. There are two acceptable procedures; these being the biliopancreatic bypass procedure (BPD) and the biliopancreatic bypass with duodenal switch operation (BPD-DS). Ensure your surgeon is qualified and trained to pursue this operation by having a look at our accredited teams and hospitals.
The jejunoileal bypass procedure (JIB) is also a malabsorptive procedure, however, it is banned in South Africa. This procedure has unacceptably high longterm complication rate resulting in poor quality of health and decreased longevity in a significant number of patients who underwent this procedure.
With all malabsorptive procedures, these operations are surgically challenging; particularly when performed laparoscopically.
If one rates a laparoscopic cholecystectomy as being a level 1 difficulty, an AGB would be a level 2, a Gastric Bypass level 5 and a BPD-DS level 10 difficulty.
The recommendation is that these complex procedures should only be attempted by an experienced centre when they have performed at least 300 gastric bypass cases.
We have clearly indicated on our accredited centres page who is accredited to do more complex procedures