Many patients who see us in
consultation are candidates
for either Gastric Bypass or
the LAP-BAND®
surgery. In such cases,
should the patient undergo
gastric bypass or LAP-BAND®
surgery?
How is this decision
made?
Some patients find it
difficult to decide which
procedure is right for them.
This can be a difficult
decision and we encourage
you to take your time and do
your research. Other things
that may help you make your
decision include: attending
support group meetings,
talking with past patients,
meeting with the dietitian
or surgeon and discussing
your concerns.
There will be times when you
may not have a choice:
*Certain insurance companies
will only pay for certain
procedures, or
*Certain medical conditions
are contra-indicated with
certain procedures
With consideration to the
above listed suggestions and
issues, if you still are
having difficulty deciding,
consider the following:
-
If you live far away from
the surgeon, will it be
difficult to have
adjustments?
-
Do you have a “sweet
tooth?” You will have less
success with the LAP-BAND®
-
Are you a heavy
snacker? You may have less
success with the LAP-BAND®
-
Are you really
scared of the Gastric
Bypass? The LAP-BAND®
may be a better choice.
The LAP-BAND®
requires tremendous
commitment and self
control. If you chose to
eat unhealthy, high fat and
high sugar foods, it will be
very difficult to lose
weight.
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 LAP-BAND®
must be adjusted
for best success |
Comparing
the Procedures
Patients
generally have
more success
with gastric
bypass
operations than
restrictive
procedures.
Risks are
similar for
both
restrictive and
gastric bypass
procedures.
Except the risk
of nutritional
deficiencies
for iron,
calcium, and
Vitamin
B12--are higher
in patients who
undergo gastric
bypass
operations.
Also, there is
risk of
intestinal
leaking.
Gastric bypass
operations also
may cause
"dumping
syndrome." This
is when food
moves too fast
through the
small
intestine. It
causes nausea,
weakness,
sweating,
faintness, and
sometimes
diarrhea.
Open vs.
Laparoscopic
Surgery
Open and
laparoscopic
refer to how
abdominal
cavity is
entered and not
the type of
surgery being
performed. So
each type of
weight loss
surgery may be
performed as
either an open
or a
laparoscopic
procedure.
When performing
open surgery,
surgeons create
a single
incision to
open the
abdomen for the
operation.
Typically, for
women it is 4
1/2 to 6
inches, and for
men, it is 5
1/2 to 7
inches.
With
laparoscopic
surgery,
multiple, small
incisions are
made in the
abdominal wall
to accommodate
a small video
camera and
surgical
instruments.
The surgeon
views the
procedure on a
separate video
monitor. Most
laparoscopic
surgeons
believe this
gives them a
better view and
access to key
structures.
