Lap Band Surgery versus Gastric Bypass Surgery

LAP-BAND System

Gastric Bypass

Description

A restrictive procedure, during which an inflatable 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, a patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion.

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.

Advantages

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

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

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

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).

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)

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
Leaks from staple lines
Nutritional deficiencies

Costs and 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.

Recovery Timeline

Hospital stay is usually less than 24 hours
Most patients return to normal activity within 1 week
Full surgical recovery usually occurs within about 2 weeks

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


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