Band Versus Bypass

Weight Loss Surgeries

If non-surgical methods have not helped you lose weight long-term, you still have another option. Studies demonstrate that weight-loss surgery, as compared to non-surgical treatments, yields the longest period of sustained weight loss in patients who have failed other therapies. But keep in mind that a positive attitude, self-discipline, and the ability to plan ahead are key for the success of any weight loss surgery. Surgery can help you achieve your long-term goal only if you are ready to make a commitment to losing weight and keeping it off.

The most common weight-loss approach is to eat less, eat sensibly, and exercise more. However, studies have shown that patients on diets, exercise programs, or weight-loss medication lose approximately 10 percent of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years.The cycle of losing weight and gaining it back is called the “yo-yo effect.” While temporary weight loss can help, the yo-yo effect can also make it harder to lose weight in the future. The National Institutes of Health report that 90 percent of the people who participate in diets and weight-reduction programs do not experience significant and sustained weight loss.

For seriously overweight individuals, weight-loss surgery should be strongly considered when other therapies have failed, as a way to lose weight, improve their health and increase their quality of life.

There are several categories of weight-loss (bariatric) surgery:

Restrictive — reduces the amount of food the stomach can hold but doesn’t interfere with normal digestion of food and nutrients.

Malabsorptive — shortens the digestive tract to limit the number of calories and nutrients that can be absorbed.

Combination — restricts the amount of food the stomach can hold and reduces the number of calories absorbed by altering the digestive tract.

The two most commonly performed weight-loss procedures in the United States are the gastric bypass (combination procedure) and the LAP-BAND® System (restrictive procedure)

1. American Society for Bariatric Surgery Web site. April 8, 1998. Available at: http://www.asbs.org/html/patients/rationale.html. Accessed April 2006. 2. American Association of Clinical Endocrinologists (AACE) / American College of Endocrinology (ACE) Statement on the Prevention, Diagnosis, and Treatment of Obesity (1998 Revision). AACE/ACE Obesity Task Force. Endocr Pract. 1998;4:297-330.

How to choose

There are many important distinctions between LAGB surgery and gastric bypass surgery.  If you look at the common complications of weight loss surgery, we feel the LAGB is much safer. Many complications related to the gastric bypass do not exist with the Gastric-Band.  Band complications are less frequent, less severe and usually easily fixed as an outpatient.

Side-by-side

 

	LAGB System	Gastric Bypass
Description	A restrictive procedure, during which an inflatable band is placed around the upper part of the stomach. This creates a smaller stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result, a patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion.	A combination procedure that uses both restrictive and malabsorptive elements. First the stomach is stapled to make a smaller pouch. Then most of the stomach and part of the intestines are bypassed by attaching (usually stapling) a part of the intestine to the small stomach pouch. As a result, a patient cannot eat as much and absorbs fewer nutrients and calories.
Advantages	Lowest mortality rate1 Least invasive surgical approach No stomach stapling or cutting, or intestinal re-routing Adjustable Reversible Lowest operative complication rate Very low risk of nutritional deficiencies	Rapid initial weight loss Minimally invasive approach is common Longer clinical experience in the U.S. Slightly higher total average weight loss reported than with purely restrictive procedures
Disadvantages	Slower initial weight loss Regular follow-up critical for optimal results Requires an implanted medical device In some cases, effectiveness can be reduced due to band slippage In some cases, the access port may leak and require minor revisional surgery	Cutting and stapling of stomach and bowel are required More operative complications Portion of digestive tract is bypassed, reducing absorption of essential nutrients Medical complications due to nutritional deficiencies "Dumping syndrome2" can occur Non-adjustable Extremely difficult to reverse Higher mortality rate Erratic absorption of medications Protein malabsorption Pregnancies are higher risk Vitamin deficiencies are possible if supplements are stopped
Results	Although during the first year after surgery, weight loss with the gastric bypass is greater than with the LAP-BAND® System, surgeons report that at 5 years many LAP-BAND® and gastric bypass patients achieve comparable weight loss (55% for LAP-BAND® and 59% for Gastric Bypass).3
Risks1,4	Mortality rate: 0.05% Total complications: 9% Major complications: 0.2% Most common include: Standard risks associated with major surgery Nausea and vomiting Band slippage (minor revisional surgery) Band erosion (minor revisional surgery) Access port problems (minor revisional surgery)	Mortality rate: 0.5-2% Total complications: 23% Major complications: 2.1% Most common include: Standard risks associated with major surgery Nausea and vomiting Separation of stapled areas (major revisional surgery) Leaks from staple lines (major revisional surgery) Nutritional deficiencies
Recovery Timeline5	Hospital stay is usually less than 24 hours (Typically this procedure is day surgery) Most patients return to normal activity within 1 week Full surgical recovery usually occurs within about 2 weeks	With a laparoscopic approach: Hospital stay is usually 48-72 hours Many patients return to normal activity within 2.5 weeks Full surgical recovery usually occurs within about 3 weeks

1. Executive summary: Laparoscopic adjustable gastric banding for the treatment of obesity (Update and Re-appraisal). The Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIPS) 2002; 1. (Laparoscopic adjustable gastric banding surgery, like the LAP-BAND surgery, is associated with a mean short-term mortality rate of around 0.05% compared to 0.50% for Gastric Bypass and 0.31% for Vertical Banded Gastroplasty.)
2. “Dumping syndrome” is a physiological reaction frequently seen following gastric bypass surgery, which is designed to alter anatomy and interrupt normal digestion. Whenever patients eat foods such as sugar and sweets, they may experience symptoms of nausea, flushing and sweating, light-headedness, and watery diarrhea.
3. O’Brien P, Dixon J, LAP-BAND®: Outcomes and Results, J of Laparoend & Adv Surg Techniques, 13(4), 2003, 265-270.
4. Parikh M, Laker S, Weiner M, Hajiseyedjavadi O, Ren CJ, Objective Comparison of Complications Resulting from Laparoscopic Bariatric Procedures, J Am Coll Surg, 2006;202:252–261. For detailed LAP-BAND® System risk information, please visit the Risk Information page.
5. Fisher B. Comparison of Recovery Time after Open and Laparoscopic Gastric Bypass and Laparoscopic Adjustable Banding, Obes Surg, 14, 2004, 67-72.