Gastric Bypass vs. Lap Band
Many patients who see us in consultation are candidates for either the Lap gastric bypass or the Lap-Band. In such cases, should the patient undergo gastric bypass or Lap-Band? How is this decision made?
After careful discussion and consideration, we have realized that we don't know which procedure is best for many patients. In fact, we are not aware of any surgeons who know of a way to determine which procedure fits best with which patient. The upshot is that the patient must decide.
To help patients make their own best decision about which procedure they should undergo, we offer this table:
| Roux-en-Y Gastric Bypass | Lap-Band |
|---|---|
| Gold standard, time tested | Promising new technology |
| Complex operation, multiple areas of abdomen involved | Simpler operation, gives lower risk around surgery (less chance of death or prolonged hospitalization) |
| Rapid weight loss over 3-6 months, settling at final weight 10-16 months after surgery | Slow and steady weight loss, settling at final weight around 2 years after surgery |
| Deficiency in mineral absorption, requiring long-term supplements | Possible deficiencies due to decreased intake, long-term supplements also recommended |
| Dumping syndrome (intolerance to sugars and some carbohydrates) | No Dumping syndrome |
| Not reversible | Sort of reversible |
| No significant hardware in body | Long term (non-reactive) plastic material in body |
| The Band must be adjusted for best success |
There are a few medical situations where a patient usually should not undergo Lap-Band surgery:
- severe GERD or problems with esophagus function
- prior surgery on the stomach itself (surgery on other parts of the abdomen is OK)
- home located more than 4 hours drive from the surgeon - the Band needs close follow-up and surgeon access
On the other hand, there are a couple of situations where the Band is a bit more appealing than the gastric bypass:
- elderly - since the Band is a lower impact procedure it may get frail patients through surgery with less risk
- patients who do not need massive weight loss
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