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Weight Loss Options

Comparing Gastric Banding to Non-Surgical Weight Loss and Gastric Bypass

Non-Surgical Treatment

The most common approach for losing weight is to eat less and exercise more. Sometimes, these efforts are successful in the short term. However, for people who are morbidly obese, the results rarely last.
Recent research reveals that conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients on diets, exercise programs, or medication are able to lose approximately 10% of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years. Another study found that less than 5% of patients in weight loss programs were able to maintain their reduced weight after five years.

Surgical Treatment

Over the years, weight-loss surgery has proven to be a successful method for the treatment of morbid obesity. Surgical options have continued to evolve. Comparison of Surgical Options

LAP-BAND® System

Description: A restrictive procedure, in which an inflatable band is placed around the upper part of the stomach, creating 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, a patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion.

Gastric Bypass
Description: A combination procedure that uses both restrictive and malabsorptive elements. 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. As a result, a patient cannot eat as much and absorbs fewer nutrients and calories.

Lapband Advantages:

Lowest mortality rate
Least invasive surgical approach
No stomach stapling or cutting, or intestinal re-routing
Adjustable
Reversible
Lowest operative complication rate
Low malnutrition risk

Gastric Bypass Advantages:

Rapid initial weight loss
Minimally invasive approach is common
Longer clinical experience in the U.S.
Slightly higher total average weight loss reported than with purely restrictive procedures

Lap band Disadvantages:

Slower initial weight loss
Regular follow-up critical for optimal results
Requires an implanted medical device
In some cases, effectiveness can be reduced due to band slippage
In some cases, the access port may leak and require minor revisional surgery

Gastric bypass Disadvantages:

Cutting and stapling of stomach and bowel are required
More operative complications
Portion of digestive tract is bypassed, reducing absorption of essential nutrients
Medical complications due to nutritional deficiencies
"Dumping syndrome" can occur
Non-adjustable
Extremely difficult to reverse
Higher mortality rate
Results: Although during the first year after surgery, weight loss with the gastric bypass is greater than with the LAP-BAND® System, surgeons report that at 5 years many LAP-BAND® and gastric bypass patients achieve comparable weight loss (55% for LAP-BAND® and 59% for Gastric Bypass on one study).

LapBand Risks:
Mortality rate: 0.05%
Total complications: 9%
Major complications: 0.2%
Most common include:

Standard risks associated with major surgery
Nausea and vomiting
Band slippage (minor revisional surgery)
Band erosion (minor revisional surgery)
Access port problems (minor revisional surgery)

Gastric Bypass Risks
Mortality rate: 0.5-2%
Total complications: 23%
Major complications: 2.1%
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

Cost & Insurance

[Generally speaking, both procedures will be covered by insurance, but check with your employer or your surgeons office for specific information about your policy.
Costs of LAP-BAND® surgery and Gastric Bypass surgery will vary depending upon 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. One survey of cash prices for both procedures showed the average charge for a LAP-BAND® procedure of $17,500 while the average charge for a laparoscopic gastric bypass was $22,500. The survey did not find any program that offered a cash price for open gastric bypass.

LapBand Recovery Timeline

Hospital stay: Most patients will go home the same day of surgery
Most patients return to normal activity within 1 week
Full surgical recovery usually occurs within about 2 weeks

Gastric Bypass Recovery Timeline

Hospital stay is usually 48-72 hours
Many patients return to normal activity within 2.5 weeks
Full surgical recovery usually occurs within about 3 weeks.