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RYGB, laparoscopic adjustable gastric band (LAGB), and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed weight loss surgeries (Figures 3.1–3.3). Gastric band and sleeve gastrectomy are restrictive procedures (meaning that they cause limitation to food intake), while the RYGB has been described as a procedure whose effects are related to a combination of gastric restriction and intestinal malabsorption. Despite these classifications, it has become clear that all weight loss procedures have metabolic effects, which may contribute more significantly to postoperative weight loss than can be explained simply by gastric restriction and intestinal malabsorption alone.

Figure 3.1 Pencil drawing of RYGB.

Source: Penn Medicine

In the RYGB, a small stomach pouch is created and the jejunum is divided. The distal limb of the jejunum is then connected directly to the small gastric pouch, bypassing the rest of the stomach and the proximal intestine. The small bowel is then placed in continuity with itself more distally, thereby providing a route for biliopancreatic secretions to mix with food. The small size of the stomach limits the capacity of food intake, while calorie and fat absorption is limited as the majority of the stomach and duodenum are bypassed.

The LAGB is a laparoscopic procedure where an inflatable silicone band is placed around the upper part of the stomach, creating a tiny new stomach pouch that limits the capacity to take in large amounts of food. The band position results in a small stomach outlet that leads to slowing of upper gastric emptying and increases the sensation of satiety. The band is able to be inflated and deflated by injecting a needle through the skin into a port connected to the band to adjust the size of the opening from the gastric pouch. Gastric banding has the benefit of being relatively reversible and minimally invasive, as it requires no cutting or stapling of the stomach or bowel (Figure 3.4).

Figure 3.2 Pencil drawing of LAGB.

Source: Swedish Health Services

Figure 3.3 Pencil drawing of LSG.

Source: UNC Medical Center

Figure 3.4 Pencil drawing of how to deflate port on LAGB.

Source: Reproduced from Hamdan et al. (2011)

The LSG is performed by removing 75–80% of the stomach and leaving a long gastric tube or sleeve of the stomach, thereby restricting intake. This procedure was initially part of a staged approach to more complex weight ‐loss procedures but has been shown to offer significant weight loss and improvement of comorbid conditions such that it is currently offered as a stand‐alone procedure.