“What do you see as a better choice for me?”
This is a question all prospective weight-loss surgery patients should ask their doctor.
Not so long ago, the idea that there could be any surgical approach weight loss was new and outlandish. But in 2008, it is estimated that more than 220,000 people underwent some form of bariatric surgery, primarily for weight-loss purposes. And since there are now several different types of surgery available, it is important for patients to be fully informed about the pluses and minuses of each procedure so that they can choose the best option for their individual circumstances.
Two types of bariatric surgery have emerged as the top recommendations for most people: laparoscopic adjustable gastric banding (e.g., LAP-BAND) and Roux-en-Y gastric bypass. Weight loss results for both are quite similar: three years after surgery, banding patients have lost an average of 55 percent, compared to 58 percent for bypass patients.
Lap Band versus Gastric Bypass (Roux-en-Y)
So what are the major differences between the two procedures?
LAP-BAND gastric banding is a laparoscopic procedure. An adjustable silicone band is placed around the top of the stomach, creating a little pouch, with a narrow passage to the main stomach compartment. It only takes a small portion of food to fill up the pouch, leading the person to feel full. Patients eat less, and the food they eat passes more slowly through the stomach and into the digestive tract.
Gastric bypass is a more complex and invasive procedure. As in gastric banding, the size of the stomach is reduced, in this case by stapling. Then, however, the new, smaller stomach chamber is surgically attached directly to the small intestine, bypassing the main part of the stomach and the upper part of the intestinal tract. As obesity and bariatric surgery expert Dr. John B. Dixon, of the Monash University Department of Surgery in Melbourne, Australia, explains, gastric bypass “requires cutting of the stomach, cutting of the bowel, re-plumbing of the bowel—so there’s cutting, there’s stapling, and there’s a diversion—there’s a re-routing of the intestine.”
Again, patients eat less, but food passes quite quickly into the intestines, which can trigger an extremely unpleasant “dumping syndrome” if they eat too much fat. There is also no opportunity for nutrients to be absorbed by the stomach and the upper part of the digestive tract, leading to nutrition deficiencies that require lifelong supplementation.
Gastric Bypass Advantages
Gastric bypass has some significant things going for it. It has been around longer (it was invented in the 1960s), so there is more data available about risks, results, and best practices. Initial weight loss is very rapid, and the total weight loss is somewhat higher on average than with gastric banding procedures. Some less-invasive surgical techniques have also been developed in recent years.
Gastric Bypass Disadvantages
On the downside, gastric bypass is a far more complex surgical procedure, with more potential complications during the operation and afterwards. Mortality rates immediately following surgery are higher. A gastric bypass cannot be adjusted in any way and is not reversible.
Lap Banding Advantages Over Gastric Bypass
Within the past five years gastric banding has become the more popular weight loss surgery among both patients and doctors, largely due to the fact that it is less invasive and safer. The short-term mortality rate is 10 times lower. As one patient notes, “This is a no-brainer; they don’t have to cut me open. It’s reversible if I need it to be.” Gastric banding does not interfere with the body’s nutritional absorption and is also adjustable, both of which are important for women who become pregnant following surgery and have greater nutritional needs during pregnancy and breastfeeding. Hospital stays are shorter (sometimes unnecessary) and recovery is somewhat faster with LAP-BAND surgery as well.
Here are the Lap-Band System Advantages in short:
- Surgery Is Minimally Invasive
- Fewer Risks and Side Effects
- Effective Long Term Weight Loss
LAP-BAND gastric banding does lag behind gastric bypass in a few areas. Weight loss tends to be slower, though it generally results in a steady loss of around two pounds per week. To achieve the best results, it also requires regular brief follow-up visits to the doctor so that the band can be adjusted to the patient’s changing weight and to be sure that the system doesn’t slip out of position. Occasional minor follow-up can be required if the band’s access port experiences leakage or the tube becomes twisted.
Despite these drawbacks, increasing numbers of weight loss candidates seem to be agreeing with LAP-BAND System patient Tami: “When I looked into the LAP-BAND it just seemed like that was my last hope, the last chance for me to get rid of this weight and to change my life.”