Gastric Bypass vs Lap-Band

There are several categories of obesity weight-loss procedures:

  • Restrictive – reduces the amount of food the stomach can hold but doesn’t interfere with normal digestion of food and nutrients.
  • Malabsorptive – shortens the digestive tract to limit the number of calories and nutrients that can be absorbed.
  • Combination – restricts the amount of food the stomach can hold and reduces the number of calories absorbed by altering the digestive tract.

The two most commonly performed weight-loss procedures in Canada are the gastric bypass (combination procedure) and the LAP-BAND® System (restrictive procedure).

LAP-BAND® System

Gastric Bypass

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 rate1
  • Least invasive procedure
  • No stomach stapling or cutting, or intestinal re-routing
  • Adjustable
  • Reversible
  • Lowest operative complication rate
  • Low malnutrition risk
  • Rapid initial weight loss
  • Minimally invasive procedure 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 medical procedure
  • Cutting and stapling of stomach and bowel are required
  • More operative complications
  • Portion of digestive tract is bypassed, reducing absorption of essential nutrients

Results

Although during the first year after the procedure, weight loss with the gastric bypass is greater than with the Lap Band® System, surgeons report that at 5 years many Lap Band® SYSTEM and gastric bypass patients achieve comparable weight loss (55% for Lap Band® System and 59% for Gastric Bypass).3(same)

Risks

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

  • Standard risks associated with major medical procedures
  • Nausea and vomiting
  • Band slippage (minor revisional medical procedures)
  • Band erosion (minor revisional medical procedures)
  • Access port problems (minor revisional medical procedures)
Mortality rate: 0.5-2%
Total complications: 23%
Major complications: 2.1%Most common include:

  • Standard risks associated with major medical procedures
  • Nausea and vomiting
  • Separation of stapled areas (major revisional medical procedures)
  • Leaks from staple lines (major revisional medical procedures)
  • Nutritional deficiencies

Costs and Insurance

Generally speaking, both procedures will be covered by insurance, but check with your employer or your weight-loss clinic for specific information about your policy. Costs of LAP-BAND® System and Gastric Bypass procedures 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® SYSTEM procedure of approximately $16,000 CDN which covers the procedure and 5 years of follow-ups and adjustments. While the average charge for a laparoscopic gastric bypass was approximately $25,000.00 USD. The survey did not find any program that offered a cash price for open gastric bypass.(Same)

Recovery Timeline

  • Hospital stay is usually less than 24 hours, and in many case the patient is home the same day
  • Most patients return to normal activity within 1 week
  • Full procedural recovery usually occurs within about 2 weeks
With a laparoscopic approach:

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

Learn more about Lap Band vs Gastric Bypass with SmartShape.

References:

  1. Executive summary: Laparoscopic adjustable gastric banding for the treatment of obesity (Update and Re-appraisal). The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIPS) 2002; 1. (Laparoscopic adjustable gastric banding surgery, like the LAP-BAND®surgery, is associated with a mean short-term mortality rate of around 0.05% compared to 0.50% for Gastric Bypass and 0.31% for Vertical Banded Gastroplasty.)
  2. “Dumping syndrome” is a physiological reaction frequently seen following the gastric bypass procedure, which is designed to alter anatomy and interrupt normal digestion. Whenever patients eat foods such as sugar and sweets, they may experience symptoms of nausea, flushing and sweating, light-headedness, and watery diarrhea.
  3. O’Brien P, Dixon J, LAP-BAND®: Outcomes and Results, J of Laparoend & Adv Surg Techniques, 13(4), 2003, 265-270.
  4. Parikh M, 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.
  5. Fisher B. Comparison of Recovery Time after Open and Laparoscopic Gastric Bypass and Laparoscopic Adjustable Banding, Obes Surg, 14, 2004, 67-72.
Gastric Bypass vs Lap-Band last modified: February 16th, 2016 by Centric Health


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