Gastric Bypass vs. LapBand - Types of Weight Loss Surgery - Types of Weight Loss Surgery


The Weight-Loss Surgery Connection > Types of Weight Loss Surgery > Types of Weight Loss Surgery > Gastric Bypass vs. LapBand

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Melissa Parish
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Joined:	Saturday October 22nd, 2005
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^{We found this excellent little explanation of Gastric Bypass and Lapband. Thought it would be helpful for those researching:}

Definition

Gastric bypass surgery is one type of procedure that can be used to cause significant weight loss if you are very obese. The surgery reduces your body's intake of calories. Calorie reduction is accomplished in two ways:

After the surgery, your stomach is smaller. You feel full faster and learn to reduce the amount that you eat at any given time.
Part of your stomach and small intestines are literally bypassed (skipped over) so that fewer calories are absorbed. Unfortunately, sometimes nutrients are lost as well.

The surgery is only right for you if you meet certain strict criteria described later in this article.

Overview & Description

Prior to any weight loss operation, your doctor will give you a complete medical examination and evaluate your overall health.

A psychological evaluation will be given to you. This will determine whether you are ready to adhere to a healthier lifestyle. If you are not ready to make lifestyle changes (and have not tried hard to do so already), you will not be considered eligible for the procedure. Without changing your lifestyle, the surgery will not be a success.

You will also receive extensive nutritional counseling before (and after) your surgery.

The surgery is performed under anesthesia. There are two basic steps:

STEP 1 -- The first step in the surgical procedure makes your stomach smaller. The surgeon divides the stomach into a small upper section and a larger bottom section using staples that are similar to stitches. The top section of the stomach (called the pouch) will hold your food.
STEP 2 -- After the stomach has been divided, the surgeon connects a section of the small intestine to the pouch. When you eat, the food will now travel from the pouch through this new connection ("Roux limb"), bypassing the lower portion of the stomach. The surgeon will then reconnect the base of the Roux limb with the remaining portion of the small intestines from the bottom of the stomach, forming a y-shape.

This "y-connection" allows food to mix with pancreatic fluid and bile, aiding the absorption of important vitamins and minerals. You still may experience poor absorption of certain nutrients.

The risk of malabsorption is of greater concern in gastric surgeries that skip over a larger portion of the small intestines. These are performed much less commonly than the Roux-en-Y gastric bypass as described.

LAPAROSCOPY

Gastric bypass can be performed using a laparoscope. This less-invasive technique allows the surgeon to make smaller incisions, which lowers the risk of large scars and hernias after the procedure.

First, small incisions are made in your abdomen. The surgeon passes slender surgical instruments through these narrow openings. The surgeon also passes a camera (laparoscope) through one of these small openings and watches through a lens and video monitor to do the surgery.

OTHER TYPES OF WEIGHT LOSS SURGERIES

Surgeries for weight loss are classified into two categories:

Restrictive procedures reduce the size of your stomach.
Malabsorptive procedures reduce the size of your stomach, plus they cause the poor absorption of calories, vitamins, and minerals.

Gastric bypass is a malabsorptive procedure. This type of surgery is more successful for weight loss than restrictive surgeries, but your body may not absorb vitamins and minerals properly.

Restrictive surgeries are performed less often. The small stomach pouch is created using bands (known as gastric banding) and/or staples (often called "stomach stapling"). The surgeon leaves a narrow passage in the newly created pouch so that food can still go through the remainder of the stomach and small intestines. Only, it does so much more slowly.
Restrictive procedures are not as successful. It is easy to "cheat" and eat too much food, over-stretching the newly created stomach pouch.

Melissa Parish
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Joined:	Saturday October 22nd, 2005
Location:	Tampa, Florida USA
Posts:	1263

Laparoscopic RNY Gastric Bypass vs LAP-BAND

Laparoscopic RNY Gastric Bypass still comprises over 80% of all weight loss operations in the United States for good reasons, and is predominant in the best medical centers. LAP-BAND, on the other hand, was given to only the most respected bariatric surgeons in this country by the FDA to trial around 2000. Despite receiving FDA approval in 2001 it has been rejected almost universally by those American experts in favor of gastric bypass because of unacceptable long term results. Furthermore, surgeons in Europe who have “banded” for over a decade (almost universally) are starting to do gastric bypass preferentially, or as “rescue or revision” operations on their failed LAP-BAND patients. Nevertheless, LAP-BAND is an easy operation to perform, with few early complications associated with the operation itself. As such, it is very popular with surgeons starting to do bariatric surgery, and has led to alarmist and sometimes absurd references to outdated and antiquated data about gastric bypass in order for those surgeons to promote the LAP-BAND. No mention is made by those surgeons of the poor weight loss results, and the more alarming long-term complications associated with LAP-BAND.

An ideal operation should accomplish two goals:

Provide optimal weight loss.
Allow for normal eating habits and lifestyle indefinitely.

FACTS AND MYTHS

THE OPERATION

FACT:

Laparoscopic RNY Gastric Bypass is a difficult operation to perform safely and may require the experience of 100 operations for a surgeon to attain excellence – but that goal can be accomplished. One simply needs to search for an experienced surgeon performing laparoscopic gastric bypass.
-Schauer, P. et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.
Surgical Endoscopy. Vol. 17, 2003

LAP-BAND is easy to perform and is therefore a “safe” operation.

WEIGHT LOSS

MYTH:

LAP-BAND is “as effective for weight loss as Laparoscopic RNY Gastric Bypass”.

FACT:

Six of the best bariatric centers in the country doing Laparoscopic Gastric Bypass have demonstrated “excess body weight loss” (EBWL) of 69 to 84% at one year. We have averaged 82% EBWL at one year in almost 200 patients, and many of our patients reach “ideal body weight”.

Most reports of weight loss with LAP-BAND range from 45 to 55% EBWL, with one of the best reports coming from Australia at 57%—that took six years to attain. Many experts believe that almost 50% of LAP-BAND patients have less than 50% EBWL (generally regarded as a surgical failure).

With LAP-BAND “… weight loss was insufficient in slightly over 40% of the patients…”
-Suter, M., et al. Laparoscopic Gastric Banding: A prospective randomized study…
Annals of Surgery, January, 2005.

A comparison of weight loss with bypass and banding, respectively, in 1200 patients showed EBWL “… 74.6% versus 40.4% at 18 months…”.
-Gagner, M. Laparoscopic Gastric Bypass versus Laparoscopic Adjustable Gastric Banding: A Comparative Study of 1200 Cases.
Journal of the American College of Surgeons, October, 2003.

RISK OF DEATH FROM OPERATION

MYTH:

LAP-BAND is much safer than Laparoscopic RNY Gastric Bypass.

FACT:

The mortality rate with LAP-BAND is boasted to be about 0.05%. Mortality rate from recent data at six reputable centers doing Laparoscopic Gastric Bypass (including ours) which comprised a total of 2389 patients was 0.08%. This difference is not even statistically significant!

RISK OF COMPLICATIONS FROM SURGERY

MYTH:

LAP-BAND has fewer complications than Laparoscopic Gastric Bypass.

FACT:
The 1200 patient comparative study showed an “early complication rate” (first week after operation) of 4.2% with bypass and 1.7% with banding. “Late complications” (the first 18 months after operation) occurred in 8.1% with bypass and 9.1% with banding. Beyond this time, however, bypass patients will have almost none, while the band patients, with the foreign body in place, will see inexorable progression of complications over time.

One “estimate of the failure rate (from complications with bands) indicates that removal is expected in almost one out of ten patients every year”.
-Scopinaro, N., et al. Thirteen Years of Follow-up in Patients with Adjustable Silicone Gastric Banding for Obesity: Weight Loss and Constant Rate of Late Specific Complications.
Obesity Surgery, Volume 14, 2004.

In another scientific surgical report there were 44% “late complications in 103 patients…20% had to be converted to gastric bypass…”.
-Weber, M., et al. Laparoscopic Gastric Bypass is Superior to Laparoscopic Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery, December, 2004.

“Increasing experience with LAGB (bands) has shown a high incidence of long-term failure and complications…15-58% of the cases. Most of these complications require reexploration.”

“ As more than 70,000 patients worldwide have received a gastric banding over the past decades, it can be predicted that many patients will require ‘rescue’ or revision operations.”
-Mognol, P. et al. Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: A review of 70 patients. Obesity Surgery. Vol. 14, 2004.

“… increasing experience with laparoscopic gastric banding (LAP-BAND) has shown a high incidence of long term failure…it can be predicted that we will see many patients requiring rescue procedures…”
-Clavien, P. et al. Laparoscopic Roux-en-Y Gastric Bypass, but Not Re-banding, Should Be Proposed as Rescue Procedure for Patients with Failed Laparoscopic Gastric Banding.
Annals of Surgery. December, 2003.

REVERSIBILITY

MYTH:

LAP-BAND is reversible. (As though the other operations were not!)

FACT:

If one could conjure up a scenario why a weight loss operation would have to be reversed, laparoscopic gastric bypass could be reversed with a laparoscopic procedure at many institutions with a two day hospitalization and one week recovery.

Why would you tout a treatment for a lifelong disease such as obesity as having the benefit of being temporary, unless you knew it would have to be temporary? Obesity would return rapidly. A good operation should be done “for life”, and provide normal eating patterns and normal quality of life. Thousands of patients are now twenty years out from their Roux-en-Y gastric bypass with no problems, whatsoever.

LONG TERM WEIGHT LOSS MAINTENANCE

MYTH:

With RNY you will regain your weight.

FACT:

It has been documented with long term follow-up that weight loss remains excellent over five years after the operation.
-MacLean, L., et al. Late Outcome of Isolated Gastric Bypass.
Annals of Surgery. April, 2000.

Melissa Parish
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Joined:	Saturday October 22nd, 2005
Location:	Tampa, Florida USA
Posts:	1263

Study Compares Gastric Bypass and Gastric Banding Surgeries
on Tuesday, August 22 @ 17:04:03 CDT

July 2006 : Extremely obese patients who undergo gastric bypass procedures may have fewer complications, a greater reduction in obesity-related diseases, more weight loss and a higher level of satisfaction than those who have gastric banding procedures, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.

Obesity is increasingly prevalent in the United States, with some individuals reaching super morbid obesity, or having a body mass index (BMI) greater than 50, according to background information in the article. The weight of super morbidly obese patients has been described as being equal to or greater than 225 percent of their ideal body weight. Conditions associated with obesity in these patients, including hypertension (high blood pressure), diabetes, sleep apnea and arthritis, raise their risk for complications following bariatric (weight loss) surgery.

Wilbur B. Bowne, M.D., and colleagues at The State University of New York, Health Science Center of Brooklyn, and Lutheran Medical Center, Brooklyn, compared the outcomes among super morbidly obese patients following two commonly performed types of bariatric surgery. Laparoscopic Roux-en-Y gastric bypass involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions. In laparoscopic adjustable gastric banding, surgeons place a band-like device around the stomach, dividing the stomach into two smaller compartments. The researchers analyzed the records of 106 consecutive patients who had one of the two procedures at a single community teaching hospital between February 2001 and June 2004.

Of the 106 patients, 60 (57 percent, average age 41.9 years) had gastric banding procedures and 46 (43 percent, average age 42.8 years) underwent gastric bypass. Gastric bypass procedures took longer (121 vs. 75 minutes) and required longer hospital stays than gastric banding procedures (3.5 vs. 1.8 days). However, after 30 days, 78 percent of those who had gastric banding experienced complications, including dehydration and vomiting, compared with 28 percent of those who had gastric bypass surgery. Gastric banding patients also had more secondary operations (15 vs. three), less weight loss (a BMI decrease of 9.8 as compared with 26.5) and reported a lower rate of overall satisfaction with the procedure. Nearly 80 percent of gastric bypass patients said they were very satisfied and none were dissatisfied or regretted having had the procedure, while 46 percent of gastric banding patients were very satisfied, 35 percent were satisfied and 10 patients reported dissatisfaction or regret. One death was reported, in a gastric banding patient. All patients reported fewer comorbidities after surgery, but the decrease was more pronounced in gastric bypass patients--for example, rates of diabetes dropped from 17.4 to 0 percent in the gastric bypass group and 18.3 to 11 percent among gastric banding patients.

"Our study represents the first focused attempt to address the effectiveness of laparoscopic adjustable gastric banding compared with laparoscopic Roux-en-Y gastric bypass in super morbidly obese patients, in hopes of better defining potential benefits that may guide future treatment planning," the authors write. "In our experience, laparoscopic Roux-en-Y gastric bypass appears superior to laparoscopic adjustable gastric banding in super morbidly obese patients." (Arch Surg. 2006;141:683-689. Available pre-embargo to the media at http://www.jamamedia.org.)
Source: JAMA and Archives Journals

limeymum
WLSC Member

Joined:	Wednesday December 24th, 2008
Location:	Fort Collins, Colorado USA
Posts:	136

Mellisa, thank you for this article I have just read, it was very interesting and informative. I am so glad I am having the Roux-en-y, instead of the lap band which was my first choice. I go in tomorrow for surgery, Diane

xenie65
WLSC Member

Joined:	Tuesday February 10th, 2009
Location:	Reno, Nevada USA
Posts:	167

hmmm. well i am planning on lap band.. but have to wonder.. am i making the right choice.. anyone care to offer insight? and don't worry, i'm here for honest answers, no offense to be taken.

caf
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Joined:	Wednesday June 3rd, 2009
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these reports are dated back in Oct, of 2003, do you have any updated information? thank you, caf

Melissa Parish
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Joined:	Saturday October 22nd, 2005
Location:	Tampa, Florida USA
Posts:	1263

Actually they are 2006. You're looking at the date of Oct. 2005 since I began this board (not 2003). Look at the actual post date.

Even today, Roux-en-Y is still considered the gold standard of weight loss surgery and still continues to have a higher long term success rate.

-Melissa & Dan

butttercups
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Joined:	Sunday August 2nd, 2009
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I think you have to research both of the surgerys and make your own decisions on which is best for you. I've heard good about both. I wish the two surgerys could come together and support each other. We are all here because we have a weight problem and will always have to work on keeping the weight off so lets help each otther!!!!! PLEASE

joseph131
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The gastric banding patients also had more secondary operations, The gastric bypass surgery what is it? how is it differ from the lap band? what would be the better one to choose? what is cheaper? the gastric bypass surgery or the lap band?

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