Weight Loss Procedures: Gastric Bypass Vs. LAP-BAND

I have a family friend who recently underwent gastric bypass surgery. Thankfully she made it safely through the operation and is now recovering at home. While I wish her all the best in her battle against obesity, I began to wonder if there was something less invasive that she could have done. No; I don't mean diet pills or another overnight success guaranteeing weight loss program. I know that she, like many of us Americans, have invested into those empty promises time and time again.

After seeing a tv commercial advertising the LAP-BAND procedure, I decided to see how the two procedures compared.

Unsurprisingly, 80% of all weight loss operations in the U.S. are gastric bypasses. And, although the LAP-BAND has received FDA approval, it has to be as successful or as widely used as the gastric bypass. Below is a list of myths from the Bariatric Surgery Center of Idaho comparing the two procedures.

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".

With LAP-BAND "... weight loss was insufficient in slightly over 40% of the patients..."

A comparison of weight loss with bypass and banding, respectively, in 1200 patients showed EBWL

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.