Bariatric Surgical Procedures Adapted from Poirier et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011: published online before print March 14, 2011, /CIR.0b013e Reproduced with permission. 0

Gastric Banding (Restrictive procedure) Figure 1 The uppermost area of the stomach is encircled by a band which prevents expansion circumferentially – this section is then injected with saline on a routine basis and results in adjustment of the band until patient achieves optimum appetite control and satiety. © 2011 American Heart Association, Inc. All rights reserved.Adapted from Poirier et al and reproduced with permission.

© 2011 American Heart Association, Inc. All rights reserved. Roux-en-Y Gastric bypass (Hybrid procedure – restriction and malabsorption) Alimentary Biliopancreatic Common Figure 2 Reducing the size of the stomach by cutting off the uppermost portion and connecting it to the small intestine. 2 3 The stomach remains viable but is bypassed by all ingested food and the new stomach has a dramatically smaller capacity. The first section of the small intestine is bypassed by all ingested food resulting in some reduction in food and nutrient absorption. Adapted from Poirier et al and reproduced with permission.

1 2 3 Biliopancreatic Diversion (BPD) Alimentary Biliopancreatic Common Figure 3A Resection of the lower 2/3 of the stomach, reducing its capacity associated with the small intestinal bypass, where at least ½ of the jejunum (middle section of the small intestine) and ileum (end section of the small intestine) are disconnected from the alimentary tract and reconnected near the terminal ileum. © 2011 American Heart Association, Inc. All rights reserved.Adapted from Poirier et al and reproduced with permission.

© 2011 American Heart Association, Inc. All rights reserved Alimentary Biliopancreatic Common Biliopancreatic Diversion Duodenal Switch Figure 3B A modified version of BPD: Stomach resection consists of a sleeve gastrectomy with less drastic intestinal bypass. Adapted from Poirier et al and reproduced with permission.