LapBand vs. Gastric Bypass?

[IwAnNaLiVe 0]

I apologize if this has been posted before... I am new here so I haven't seen it. I'm seriously considering the LapBand procedure but am wondering if I should also consider Gastric Bypass. What are the benefits of LP vs. GB?

TIA!!!

[tracew 2]

I think that the choice is a personal one. GB is somewhat more complicated surgery wise, but the Lapband has complications sometimes too. Both are only tools to be used with diet and exercise, so the choice is...what can you live with? The band is fairly easily reversable...and from what I understand GB is too now. GB is readily covered by most insurances, LB isn't as much. I would weigh every option good, bad and ugly and make an informed decision. I personally was banded 3+ years ago and wouldn't go back for the world. Good Luck

POPT

Tracey

[Nykee 13]

I think the biggest consideration is YOUR eating habits.

IF your a BIG BIG eater of BIG quantities... than the BAND is IMO the best choice.

BUT, if you snack alot, eat alot of candy or Drink alot of pop and juice...

Or if you munch and graze all day.. THE LAPBAND IS NOT A GOOD CHOICE.

This is OF course ONLY if you are pretty sure you will need the WLS to do alot of the work..

[Kat817 19]

Wow! I had not heard that RNY was reversable! I am not sure how they would do it---but that is amazing!!!

I chose the band, because I did not want my parts re-routed. I wanted the ability to reverse if need be. I have heard many choose it for future pregnancy, and the ability to nurture a pregnancy normally---but that was not an issue for me!!! I am however a cancer survivor, and wanted to know I could get extra nutrition if ever I should need too. I also felt if times brought about new and improved WLS, or other WL advances, with the band, I would still be eligible to work with them too.

Most bypass patients, require supplemental nutrition forever. The bypass causes you to lose weight in 2 ways, by restriction, and by malabsorption. So you may eat a healthy diet, but because you have lost the majority of your intestines, your body gets very little nutrition from what you eat. With the band, you lose simply by restriction. Restricting how much you can eat. when you eat a healthy diet, you get full benefit from the Vitamins and nutrients in the food you eat.

The choice is a very personal one. Often times, one group will bad mouth the other. Which is sad, when in the end we all just want the same thing---to lose this weight, and feel good about ourselves.

Good Luck in your decision.

Kat

[anonemouse 1]

The band is fairly easily reversable...and from what I understand GB is too now.

RNY is reversible, but it is a much, much more complicated prodedure than removing a lap-band would be. The RNY reversal itself is likely to have complications, since the surgeon would be trying to stitch or staple everything back where it originally was. With a lap-band removal, all they have to do is go in and take off the band. No stitching parts together or anything.

[anonemouse 1]

By the way, there was a study that got published recently that basically stated that RNY and Lap-band were statistically equal in medium-term weight loss. There wasn't enough data available to analyze long-term weight loss at the time, but the way the numbers looked, Lap-band would probably be superior to RNY for long-term weight loss. The 8-year loss from Lap-band was statistically equal to the 10-year loss from RNY, which leads to the suspicion that 10-year loss from Lap-band would be statistically superior to 10-year loss from RNY.

So with that, I chose to have Lap-band because of the following reasons:

• 
  
• Ease of reversal
  
• Low mortality rate
  
• Low severe complication rate
  
• No malabsorption
  
• Adjustability
  
• Good long-term weight loss prospects
  
• Not as many "no" foods
  
• No dumping syndrome
  
• No smelly BMs or gas
  
• Healthier weight loss (slow = better chance at keeping it off)
  
• No "skeleton look"

[waterlily1072 5]

When I made the choice to get banded I personally knew people who had been banded and who had had RNY. The banded folkes looked great, they had energy and they looked healthy. The RNY folks looked weak and tired, they looked malnurished to me. I would love to have malabsorption weight loss, but I personally was not willing to risk my own health. I actually knew someone who died from direct complications of the RNY, he died within 3 days after surgery. The RNY just scares me. I still keep in the back of my mind to possibility of switching should anything happen to my band, and I think I would if I was not able to be rebanded.

[faithmd 14]

RNY is reversible, but it is a much, much more complicated prodedure than removing a lap-band would be. The RNY reversal itself is likely to have complications, since the surgeon would be trying to stitch or staple everything back where it originally was. With a lap-band removal, all they have to do is go in and take off the band. No stitching parts together or anything.

While it is technically reversible (i.e. they can reconnect the disconnected part of the stomach and short leg of intestine to what you have left), it is not truly totally reversible. The intestine that was removed has gone to the incinerator long ago. So depending on how much your surgeon removes, that affects your absorption ability forever. Laurend is correct, the complication rate is pretty high.

To the OP: Welcome to LBT! You are right, there are MANY MANY threads about this very topic. You may not have noticed, but there is a "Search" function in the blue bar about 1/3 of the way down from the top of the screen. I know it took me a while to find it, myself. I found 3 pages of threads using the advanced search and asking for titles of threads only with the word "bypass" in them. I did not search for RNY yet. I'll post the list of some from the results (first page). I am posting these because it's kind of nice to be able go and read other's responses to your question as well. Some folks who have responded in the past may not be around now. Happy reading and again, welcome, post, ask, enjoy!!

http://www.lapbandtalk.com/gastric-bypass-vrs-t30997.html?t=30997

http://www.lapbandtalk.com/advantages-bypass-t31341.html?t=31341

http://www.lapbandtalk.com/band-vs-bypass-t28724.html?t=28724

http://www.lapbandtalk.com/getting-pressured-do-t28690.html?t=28690

http://www.lapbandtalk.com/lap-band-vs-t27483.html?t=27483

http://www.lapbandtalk.com/discussion-why-people-t26103.html?t=26103

http://www.lapbandtalk.com/lap-vs-bypass-t25642.html?t=25642

http://www.lapbandtalk.com/considering-band-but-t25042.html?t=25042

http://www.lapbandtalk.com/lapband-bypass-t25022.html?t=25022

http://www.lapbandtalk.com/band-vs-gastric-t23454.html?t=23454

http://www.lapbandtalk.com/showthread.php?t=23760

And even a poll about it, too:

http://www.lapbandtalk.com/lap-band-bypass-t15886.html?t=15886

[babygrl1234 6]

So with that, I chose to have Lap-band because of the following reasons:

• Ease of reversal
  
• Low mortality rate
  
• Low severe complication rate
  
• No malabsorption
  
• Adjustability
  
• Good long-term weight loss prospects
  
• Not as many "no" foods
  
• No dumping syndrome
  
• No smelly BMs or gas
  
• Healthier weight loss (slow = better chance at keeping it off)
  
• No "skeleton look"

I dunno laurend I have been having major gas issues since my surgury. I feel bad for anyone in the room roughly 30 minutes after lunchtime.

However I will take stinky farts over the 30 lbs I have lost any day of the week.

[fabfatgrl 10]

I definitely think you really need to take an honest look at your eating habits as well as your comfort levels regarding both surgeries.

All WLS is a tool... and a tool which does a lot of the work at first, but requires more work for you long-term. That's why you read about people needing revisions LT. I know people who've had VSGs (look into that surgery as well... try ObesityHelp), RNYs, and DSs after their Lap-Band. I know quite a few RNYs who've had Lap-Bands added to their pouches due to pouch dilation.

You will probably lose slower with the Lap-Band vs. an RNY--but you will still lose. Most studies show that weight loss equalizes between the two procedures (assuming you get fills and such) 18-24 months post-op.

The big difference is the adjustability of the Band. This is good and bad. The pros are that you can adjust your Band's tightness depending on your needs/health. Great in case you get pregnant. The cons are that you will need to have regular follow-ups with your surgeon or fill person in order for your Band to work. For 95% of people (perhaps 99%), the Band is pretty much useless unless you get fills.

Most Bandsters that I know have problems with certain foods as things get tighter... bread, Pasta, meat, salad... can all cause problems. BUT, if you decide that you can't handle life without them, you can always have some fill removed.

RNYs face dumping, which Bandsters do not. Some view this as an advantage, others a disadvantage. Among RNY folks I know, the dumping effect does tend to lessen over time... so if it is something you rely on to keep you from high sugar foods, you may have to go at it alone at some time.

Lap-Band is an easier procedure, with less operative risk... mainly because the intestines are left alone... as is the stomach (no cutting). You don't hear about the hernias, adhesions, and such that some RNYers face.

One disadvantage with the Band can be longevity of the operation. I've been Banded for almost 6 years now, and I have to say... I know very few Bandsters who were Banded at the same time and still have their Bands. GERD, Band slippage/erosion, frustration with never-ending fills, slow weight loss, pouch dilation... have all caused them to choose other operations. BUT, most do not regret being Banded at first. In many ways, it's a good introduction to WLS with little risk (other than financial). With the other operations, if you decide you just can't live off of such small amounts... or hate dumping... or whatever... there's not a lot open to you other than an expensive and complicated reversal. For Bandsters, one can always have all fill removed... or chose to have the Band removed.

One other advantage is regarding Vitamin issues/etc. One doesn't hear about them nearly as often with Bandsters... as well as osteoporosis and such. Those tend to be much much more common in malabsorption ops like RNY and DS.

[faithmd 14]

RNYs face dumping, which Bandsters do not. Some view this as an advantage, others a disadvantage. Among RNY folks I know, the dumping effect does tend to lessen over time... so if it is something you rely on to keep you from high sugar foods, you may have to go at it alone at some time.

Precisely, the dumping effect tends to lessen over time, which means that weight is more easily regained. The RNY is sort of a tool, but only if that pouch stays small, and since it is made from stomach, it has a tendency to stretch easily over time. The things that keep the RNYer's honest in the beginning are basically malapsorption and malnutrition. Your body is a smart machine, it figures this out eventually. And you start utilizing food in a different way, the weight creeps back on. And your are still malnourished in terms of Vitamins, etc. You simply cannot absorb them like you did when you had your intestine intact. So eventually many start to regain, but still have Vitamin deficiencies, unless they are lucky enough to be able to absorb the supplements and take the B12 shots.

If I HAD to lose a large amount of weight FAST because of medical issues, or if I were a lot older, I'd consider RNY (probably DS, actually), but at my age and without any real comorbidities, I'm being banded. If it becomes necessary, I can always have another bariatric procedure later. But if I have the RNY now, I could possibly have it taken down if I develop problems later, but I'll never get that minimum of 22 inches (up to who knows how much) of intestine back, ever.

One disadvantage with the Band can be longevity of the operation. I've been Banded for almost 6 years now, and I have to say... I know very few Bandsters who were Banded at the same time and still have their Bands. GERD, Band slippage/erosion, frustration with never-ending fills, slow weight loss, pouch dilation... have all caused them to choose other operations.

The operative techniques have changed dramatically in the past four years alone with the band. Here's a link to a journal article about the techniques used now (and to those of you being banded, make sure to ask if your surgeon uses this technique, if s/he doesn't, I'd reconsider that surgeon) that Rockn4U posted:

http://thinforlife.med.nyu.edu/assets/REN%202.pdf?RCD=J53039

Here's the summation of what the article describes:

Excellent results have been achieved outside the

United States, with excess weight loss (EWL) averaging

53% to 65% at 3 years and major complication rates of

5%...Interestingly, the initial American experience in

the Food and Drug Administration clinical trial resulted

in a lower-than-expected rate of EWL (36%) and a

higher-than-expected rate of complications (40%).

The discrepancy between the results of the Food and Drug

Administration trial and the international results may be

partially explained by differences in surgical technique.

A correlation has been shown between surgical technique

and complications, specifically a higher rate of gastric

prolapse for the older perigastric technique than for the

pars flaccida technique (5.2% vs. 0.6%). Fielding et

al. initially described the use of the pars flaccida technique

and their subsequent 5-year results of 62% EWL,

a 3.5% rate of gastric prolapse, and 0% mortality.

Now while the article speaks specifically to US rates, the perigastric technique was not only used in the US, it was used in other countries for years as well. Other countries were just faster at changing their technique to pars flaccida than we were. Remember, our surgeons in the US were trained by Mexican and some European surgeons. US surgeons learned the perigastric technique from them. Then the International surgical community changed their tecnique to pars flaccida at the time that the US was just starting to place bands with more regularity. It always takes time to change surgical techniques, especially when the surgery being done is new to a practitioner.

[faithmd 14]

I have my surgical consult tomorrow and if the surgeon I'm seeing does not use pars flaccida, I won't be going to him. Simple as that, the statistics speak for themselves.

Since he is who my insurance pays for me to see, I don't know what I'll do if he does not use this technique, but I'll cross that bridge later.

[fabfatgrl 10]

Rumbaut used pars flaccida on me. You bring up another really important point regarding expectations with this surgery. EWL is 53-65% at 3 years, on average. Not 100%, as most people expect/want. You need to ask yourself, will I be happy if I lose only about 1/2 of the excess weight I need to lose?? Is that enough for me?? For me, it was...and it made a huge difference in my quality of life. BUT, I know a lot of people who get very upset when weight loss does stop around 50-60%.

[FurEllie 0]

• No "skeleton look"

LOL, I got a giggle out of this - I'd LOVE to have a "skeleton look" My friend and I were commenting the other day how great it would be for someone to look at us (75-150 pounds overweight now) and say "Oh my, are those ladies anorexic??";)

No, I'm not poking fun at those who have a different eating disorder than I do, but it just hit me as cute to worry about that

[juliegeraci 7]

Keep in mind that with the band you typically lose 1-2 lbs per week. It is much slower than RNY. You definitely should take that into consideration. Good luck with your decision.