Mini Gastric Bypass: We do not advise any patient to undergo the mini-loop bypass (mini-gastric bypass). This procedure is not sanctioned by the National Institutes of Health (NIH), The American Society of Bariatric Surgery, by insurance companies or by the majority of bariatric surgeons. The procedure is marketed as a quick 45-minute laparoscopic operation. Unfortunately, according to a recent report (see below), a significant percentage of patients require re-operation complications. Furthermore, some surgeons may fraudulently claim that this procedure is a standard gastric bypass in order to bill insurance companies; this may result in future legal action involving patients. Click here to read expert opinion on Mini-gastric bypass.

Vertical Banded Gastroplasty: We strongly advise against any patient to undergo the vertical banded gastroplasty (VBG). This procedure has been found to have mediocre long-term weight loss results and a high incidence of severe reflux. We believe that no patient should have this procedure done. Fortunately, we can successfully convert the VBG to a gastric bypass using laparoscopic surgery in many instances. A significant number of patients who have had this procedure will require re-operation for severe complications.

Gastric Bypass with hard Rings placed around the gastric pouch: We believe that the use of synthetic material, rings or bands, with the gastric bypass should not be performed (such as the Fobi Pouch). An example of this procedure is the vertical banded gastric bypass. We believe that there is no real proof that the added band improves long-term weight loss. In fact, persistent difficulty eating seems common with these modifications. Review of the scientific data shows that these rings may result in serious and unnecessary complications that may be life-threatening. The use of unproven "modifications" are commonly used as marketing ploys.

"Chop shop" surgeons: Patients should only undergo bariatric surgery in comprehensive bariatric surgery programs. Bariatric surgery is a science that requires multiple disciplines such as psychologists, nutritionists, internists, and surgeons, to maximize safety and success. "Chop Shops" involve surgeons who see their patients only briefly, involve specialists who have little interest or training in treatment of obese patients, and who run programs that are only superficially comprehensive. These surgeons, in our opinion, have little interest in maximizing the long-term success of their patients, provide only cursory patient education, and are interested simply in performing as many surgical procedures as they can possibly do-regardless of quality.

Traditional Open Bariatric Surgery: We believe that Laparoscopic bariatric surgery is the gold standard in the care of overweight patients. Although the majority of surgeons in this country still perform open bariatric surgery, we believe the evidence proves that laparoscopic bariatric surgery is safer than open surgery with big incisions. Nearly all patients are candidates for laparoscopic surgery. Most claims that a patient is not a candidate for the laparoscopic technique are made due to that surgeon's inability or inexperience, not due to the patient's situation-in these cases, patients should always seek a second opinion. For larger patients or patients with multiple previous abdominal operations, completing bariatric surgery using laparoscopic techniques requires specialized training in advanced laparoscopic surgery. Be cautious of surgeons who are trained only in traditional, open surgery and state that many patients are "not candidates" for laparoscopic bariatric surgery; these surgeons are misleading their patients.

Hand-Assisted Laparoscopic Operations: Many of the benefits of laparoscopy are eliminated if an incision of more than several centimeters is made to complete the procedure. Some surgeons perform mostly hand-assisted laparoscopy due to their technical inability, or inexperience with state-of-the-art laparoscopic techniques. These operations do not have the same benefits of a totally laparoscopic procedure.

Newly Developed Programs: Many hospitals are trying to get on the bandwagon and offer bariatric surgery. These hospitals may recruit surgeons who are not properly trained to perform these procedures well. When performed by very well trained surgeons, the gastric bypass can be performed in less than one hour with a hospital stay of less than 48 hours. Ask your surgeon 1) What is your leak rate - it should be less than 0.5% 2) What is your mortality rate -it should be less than 0.2% 3) What are your average operative times -it should be less than 90 minutes 4) What is your conversion to open surgery rate -it should be less than 1 percent 5) How many patients end up in the ICU - it should be less than 5 percent 6) Does your surgeon keep a database of all of his results - if he doesn't , he may not even know how good (or bad) he is doing. Bariatric surgery should be performed as a full time job. Beware of surgeons who are cancer doctors, trauma surgeons and dabble in thyroid and breast surgery in between weight loss operations. The most important factor in determining your risks of surgery is the quality of the surgical team.

 Click here to read more Frequently Asked Questions.