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Visalia Medical Clinic
5400 W. Hillsdale Drive
Visalia, CA
What is LapBand?
The LAP-BANDŽ System

LAP-BANDŽ 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-BANDŽ 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-BANDŽ 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.