What is the Difference Between Gastric Bypass and Lap-Band® Surgery?

People considering weight loss surgery as a treatment option for obesity have several surgical options to choose from, including biliopancreatic diversion, vertical banded gastroplasty (VBG), sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch, and adjustable gastric band surgery. Of these, the Roux-en-Y gastric bypass and gastric band procedures are most commonly performed. But which is better?
Both surgeries have advantages and drawbacks. Roux-en-Y gastric bypass surgery remains the most common weight loss surgery procedure. Most surgeons choose to perform the operation laparoscopically, when possible, to minimize the risk to the patient.
"With laparoscopic surgery, a doctor is able to access the abdominal cavity through several small incisions using special surgical tools," explains Dr. David Provost, a veteran bariatric surgeon who performs weight loss surgery in North Texas. "This is opposed to the open procedure, which requires the doctor to make a long vertical incision to access the digestive tract, which can increase the risk of infection."
Gastric bypass patients usually see rapid and significant weight loss, and long-term research shows that gastric bypass patients generally keep off at least 60-70 percent of their excess weight long-term. In addition, gastric bypass surgery has been proven to resolve type 2 diabetes, as well as other health conditions related to obesity, such as hypertension, joint pain and obstructive sleep apnea.
Gastric bypass does have its disadvantages, however. Gastric bypass patients generally experience a longer post-operative hospital stay and a prolonged period of recovery than those who choose the gastric band. Another complication common to gastric bypass patients is gastric "dumping", which often occurs if the patient eats certain foods that may be hard to digest, such as raw vegetables, or anything that contains a lot of sugar, including sweetened beverages. Although not life-threatening, dumping can cause serious nausea, vomiting, diarrhea, and shortness of breath.
Perhaps the most significant disadvantage of gastric bypass surgery stems from its nature as a malabsorptive procedure. Because part of the digestive system is removed during surgery, the amount of calories absorbed from food is reduced. Although this can promote rapid weight loss, it can also cause nutritional deficiencies in the patient, especially deficiencies in micronutrients such as iron, foliate, calcium, and vitamin B-12. For this reason, it is important that gastric bypass patients take regular vitamin supplements and are monitored regularly by their physicians for some time after surgery.
Laparoscopic gastric banding (commonly called Lap-Band surgery, due to the popularity of the LAP-BAND® system manufactured by Allergan, Inc.) is the second most popular type of bariatric procedure, and is quickly catching up with gastric bypass.
"In our practice, more and more patients seeking weight loss surgery in North Texas are asking about the Lap-Band procedure," says Dr. Provost. "They like the idea the fact that the surgery has a shorter recovery time, and that the procedure is reversible."
Lap-Band surgery is a restrictive procedure, in that it works by mechanically restricting the amount of food the patient can eat. Because no part of the patient's stomach or intestines are removed or rerouted during Lap-Band surgery, patients rarely experience nutritional deficiencies or malabsorption of micro-nutrients after surgery. Implantation of the band and its associated tubing and port are relatively easy and quick, compared to the time required for gastric bypass surgery, and these may be removed just as quickly. And the Lap-Band procedure itself is laparoscopic, resulting in less risk of infection and complications, less pain, a shorter hospital stay, and faster recovery than with other forms of bariatric surgery.
Disadvantages of the Lap-Band system include its reduced efficiency compared to other types of weight loss surgery, and its slower and less-dramatic rate of initial weight loss compared to that experienced by most gastric bypass patients. The band itself requires regular tension adjustments, which obligate the patient to months of additional inconvenience and the expense of follow-up visits to the doctor's office.
Lap-Band surgery or gastric bypass? Research shows that the two operations have a relatively low risk of complications and are highly effective at promoting significant weight loss, as well as the resolution of co-morbidities if the patient follows his or her physician's instructions as prescribed. Each patient is different, however, and individuals who struggle with morbid obesity should consult with an experienced bariatric surgeon prior to deciding which type of surgery is best-suited to their own case.