Dr. Joseph Manuele - VMC Weightloss Surgery - Are You a Candidate- Lap-Band vs Bypass

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Visalia Medical Clinic
5400 W. Hillsdale Drive
Visalia, CA

The LAP-BAND® System

LAP-BAND® vs Bypass

Download the printable pdf of the "Comparison of Surgical Options" here.
	LAP-BAND®	Bypass
DESCRIPTION	A restrictive procedure during which an adjustable gastric 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, patients achieve sustained weight loss by limiting food intake, reducing appetite, and slowing digestion	Gastric bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements. With this surgery, 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. The result is that you cannot eat as much, and you absorb fewer nutrients and calories
ADVANTAGES	Lower short-term mortality rate than gastric bypass Minimally invasive surgical approach No stomach stapling or cutting, or intestinal rerouting Adjustable Reversible Lower operative complication rate than with gastric bypass Low malnutrition risk	Rapid initial weight loss Minimally invasive approach is possible Longer experience in the U.S. Higher total average weight loss reported than with the LAP-BAND®
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DISADVANTAGES	Slower weight loss Regular follow-up critical for optimal results Requires an implanted medical device In some cases, effectiveness may be reduced due to slippage of the LAP-BAND® Adjustable Gastric Banding System In some cases, the access port may leak and require minor revisional surgery1	Cutting and stapling of stomach and bowel are required More operative complications than with the LAP-BAND® System Portion of digestive tract is bypassed, reducing absorption of essential nutrients Medical complications due to nutritional deficiencies may occur "Dumping syndrome" can occur Non-adjustable Extremely difficult to reverse Higher perioperative mortality rate than LAP-BAND® Adjustable Gastric Banding System
RESULTS	A review of published studies showed many laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) patients achieve comparable weight loss at 3 years and beyond (55% for LAGB and 58% for standard RYGB).6
RISKS*	Mortality rate: 0.05% Total complications: 9% Major complications: 0.2 Most common include: Standard risks associated with major surgery nausea and vomiting LAP-BAND® System slippage Stoma obstruction	Mortality rate: 0.5%3 Total complications: 23% Major complications: 2% 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
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COSTS AND INSURANCE	Generally speaking, both procedures will be covered by insurance, but check with your employer or your surgeon's office for specific information about your policy. Costs of LAP-BAND® Adjustable Gastric Banding System surgery and gastric bypass surgery will vary depending on the site where the surgery occurs (in-patient or out-patient), the type of bypass procedure (laparoscopic or open), and how long you are required to stay in the hospital.
RECOVERY TIMELINE	Hospital stay is often approximately 24 hours Most patients return to normal activity in about 1 week Full surgical recovery usually occurs in about 2 weeks	With a laparoscopic approach: Hospital stay is usually 48 to 72 hours Many patients return to normal activity within 2 to 3 weeks Full surgical recovery usually occurs within about 3 weeks
*Published complication rates vary depending upon the institution and how the surgeon diagnoses and defines a particular complication.

References: 1. Weight-control Information Network (WIN); an information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastrointestinal surgery for severe obesity. December 2004. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Accessed May 2, 2007.
2. O'Brien PE, Dixon JB. Lap-Band®: outcomes and results. J Laparoendosc Adv Surg Tech A. 2003;13:265-270.
3. Chapman A, Kiroff G, Game P, et al. Systematic review of laparoscopic adjustable gastric banding for the treatment of obesity: update and re-appraisal. Executive summary. ASERNIP-S Report No. 31. Second edition. Adelaide, South Australia: ASERNIP-S, June 2002.
4. American Society for Bariatric Surgery (ASBS). Rationale for the surgical treatment of morbid obesity. Updated November 23, 2005. Available at: www.asbs.org/html/patients/rationale.html. Accessed May 2, 2007.
5. Parikh MS, 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.
6. O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032-1040.
7. Clegg AJ, Colquitt J, Sidhu MK, et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6:1-153.
8. Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obes Surg. 2004;14:67-72.