In the last decade, a number of medical advancements have made the surgical treatment of obesity safer and less invasive. One of the most exciting developments in 1993 was the introduction of the LAP-BAND System, an inflatable ring implanted around the stomach that reduces one's appetite and facilitates weight loss by eating less food. Although the LAP-BAND procedure is the most popular weight-loss surgery around the world, the most commonly performed in the United States is still the gastric bypass. If you are considering a surgical treatment for severe obesity, the differences in the two procedures should be well understood.
Though both procedures require surgery, the approaches are very different. During a gastric bypass surgery, doctors begin by stapling the stomach to form a smaller pouch. Then, by attaching a portion of the intestines to the newly-formed pouch, the remaining stomach and intestines are bypassed, in essence removed from the digestive tract. The result is a drastically smaller internal area for food, allowing the patient to feel satiated more quickly and absorb fewer calories. Though this procedure has evolved in recent years, gastric bypass still represents one of the more invasive approaches to weight loss.
On the other hand, the LAP-BAND procedure can be performed without cutting and stapling the stomach. Rather than rerouting the intestinal tract, the LAP-BAND creates a similar feeling of satiety with a simple single inflatable band. The LAP-BAND is surgically placed around the upper portion of the patient's stomach, forming a smaller stomach pouch similar to the gastric bypass procedure. The LAP-BAND helps the patient feel full with less food intake, but also reduces the appetite by slowing digestion for a natural, healthy weight loss.
While gastric bypass and LAP-BAND procedures represent very dissimilar surgical approaches, the recoveries and extended treatment programs associated with each surgery highlight even greater differences. For instance, in addition to a ten times higher mortality rate1, gastric bypass patients typically remain in the hospital for 2-3 days while most LAP-BAND patients are able to return home the same day. Additionally, most gastric bypass patients will not be able to return to normal activities for 2-3 weeks while LAP-BAND recipients often complete their surgical recovery in 1-2 weeks.
After recovering from surgery, gastric bypass and LAP-BAND patients also experience weight loss differently. Although most patients experience rapid initial weight loss with the gastric bypass, there is no long-term mechanism to continue to maintain the feeling of satiety that can be achieved with a properly adjusted LAP-BAND. The intestinal re-routing of the gastric bypass can also contribute to nutritional deficiencies, many of which require extensive follow-up care.
In addition to a lower risk of complications from surgery, the LAP-BAND procedure also helps patients lose weight gradually and healthily, eliminating the effects of malnutrition. In the months following LAP-BAND surgery, patients tend to experience weight loss of 1 to 2 pounds a week. They are receiving all the natural nutrients of the food they consume but the portions are significantly smaller as a result of the restriction and satiety the LAP-BAND provides. In order to receive the greatest number of benefits however, it is essential that the LAP-BAND is properly adjusted. This is determined by your surgeon according to your rate of weight loss, the types of food you can consume and your sense of satiety in between meals. It's an ongoing refinement to achieve optimal results based upon your personal experience.
The LAP-BAND also avoids the uncomfortable side effect known as dumping syndrome. Experienced by many gastric bypass patients, dumping syndrome occurs when undigested food particles move too quickly into the small intestine. Similar to a state of shock, gastric bypass patients often break out in a cold sweat with a rapid heart beat and experience cramps and diarrhea.
In the event that patients want to reverse their weight loss surgeries, the LAP-BAND is considered the only reversible procedure because the internal anatomy is not changed with the placement of the LAP-BAND. As the LAP-BAND is merely implanted around the stomach without surgical manipulation of the intestinal tract, the stomach will return to its original state after removal of the LAP-BAND.
While both gastric bypass surgery and LAP-BAND surgery have been proven to be successful methods of treating obesity and sustaining long-term weight loss, the LAP-BAND procedure remains the safest and least invasive weight loss surgery available.
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.)
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