Inability to Lose Weight

Fig. 22.1

The two most common surgical procedures. (a) Adjustable gastric banding. (b) Roux en Y gastric bypass

Table 22.1

Comparison of the characteristics of the two most common surgical interventions

Characteristics	Laparoscopic adjustable gastric banding- LAGB	Laparoscopic Roux en Y gastric bypass- RYGB
Estimated cost	Circa £7,000 with band fills	£8,000–15,000
Principle technique	Reversible and restrictive	Irreversible, restrictive and malabsorptive
Weight loss	About 50 % EWL at 1 year	About 70 % EWL at 1 year
Type 2 diabetes	Higher than with diet but less than RYGB	Improvement or remission shortly after surgery (40–80 %)
After care	Repeated follow up requirement for band adjustments	Lifelong mineral and vitamin supplementation
Common complications	Band erosions, ulceration, band slippage, pouch dilation, wound infections	Anastomotic leaks, internal hernias, pulmonary embolus, sepsis, wound infections
Side effects	Nausea, vomiting, dyspepsia	Nausea, vomiting, dumping syndrome, vitamin deficiencies, malnutrition
Surgical mortality	0.05 %	0.5 % with higher risk of intra-operative complications
Revision	Required in 10–25 %, this typically to RYGB	Less common and technically difficult

Postsurgically, the patient will undergo a gradual change from fluid to solid food intake important in restrictive surgery to minimise symptoms like vomiting which can lead to reflux and increase the danger of rupture of surgical anastomoses. Adequate protein content is necessary as patients do not only lose adipose tissue but also lose lean body mass with surgery especially after malabsorptive procedures.

Nutritional reinforcement of healthy eating behaviour and food composition with exclusion of carbohydrate dense meals and drinks is necessary also after RYGB to avoid or reduce gastrointestinal symptoms such as Dumping syndrome including abdominal pain, nausea, diarrhoea, cramps, flushing, light-headedness and syncope ([2]; see also above).

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