The bariatric surgeon determines which of the following procedure will be appropriate for each patient:
Adjustable gastric banding procedures: This procedure involves implanting an adjustable band that contains saline solution around the stomach to reduce its size. This surgery is reversible, causing no permanent change in patient anatomy. As the "Lap" part of the name suggests, it is usually performed laparoscopically (through a small incision).
Vertical banded gastroplasty: Commonly known as stomach stapling, vertical banded gastroplasty is similar to the Lap-Band procedure in that the size of the stomach is physically reduced without interrupting a patient's digestive process. This less reversible procedure, however, utilizes both a band and surgical staples—and the band is not adjustable.
Sleeve gastrectomy: A restrictive stapling procedure, the sleeve gastrectomy removes a large portion of the stomach and transforms the shape of the remaining stomach from saclike to narrow and tubular. The surgery often can be performed laparoscopically.
Roux-en-Y gastric bypass: During the procedure—which is often performed laparoscopically—surgeons use approximately 5 percent of a patient's stomach to create a gastric pouch at the bottom of the esophagus. The pouch is connected directly to the middle part of the small intestine, bypassing not only the rest of the stomach but also the upper portion of the intestine, where some of the food's calories are normally absorbed. The result is a "new" stomach about the size of an egg that continues producing the enzymes and juices necessary for digestion.
Biliopancreatic diversion with duodenal switch (BPD/DS): BPD/DS surgery removes the lower section of the stomach, leaving a fairly large stomach pouch that is connected to the bottom part of the small intestine, called the distal ileum.