Comparing Surgical Procedures

DESCRIPTION

A restrictive procedure during which an adjustable gastric 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, patients achieve sustained weight loss by limiting food intake, reducing appetite, and slowing digestion

Gastric bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements. With this surgery, 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. The result is that you cannot eat as much, and you absorb fewer nutrients and calories

ADVANTAGES

• Lower short-term mortality rate than gastric bypass
• Minimally invasive surgical approach
• No stomach stapling or cutting, or intestinal rerouting
• Adjustable
• Reversible
• Lower operative complication rate than with gastric bypass
• Low malnutrition risk

• Rapid initial weight loss
• Minimally invasive approach is possible
• Longer experience in the U.S.
• Higher total average weight loss reported than with the LAP-BAND® System

DISADVANTAGES

• Slower weight loss
• Regular follow-up critical for optimal results
• Requires an implanted medical device
• In some cases, effectiveness may be reduced due to slippage of the LAP-BAND® Adjustable Gastric Banding System
• 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 than with the LAP-BAND® System
• Portion of digestive tract is bypassed, reducing absorption of essential nutrients
• Medical complications due to nutritional deficiencies may occur
• "Dumping syndrome" can occur
• Non-adjustable
• Extremely difficult to reverse
• Higher perioperative mortality rate than LAP-BAND® Adjustable Gastric Banding System

RESULTS

A review of published studies showed many laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) patients achieve comparable weight loss at 3 years and beyond (55% for LAGB and 58% for standard RYGB).

RISKS

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

• Standard risks associated with major surgery
• Nausea and vomiting
• LAP-BAND® System slippage
• Stoma obstruction

Mortality rate: 0.5%
Total complications: 23%
Major complications: 2%
Most common include:

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

COSTS AND INSURANCE

Generally speaking, both procedures will be covered by insurance, but check with your employer or your surgeon's office for specific information about your policy. Costs of LAP-BAND® Adjustable Gastric Banding System surgery and gastric bypass surgery will vary depending on 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.

RECOVERY TIMELINE

• Hospital stay is often approximately 24 hours
• Most patients return to normal activity in about 1 week
• Full surgical recovery usually occurs in about 2 weeks

With a laparoscopic approach:

• Hospital stay is usually 48 to 72 hours
• Many patients return to normal activity within 2 to 3 weeks
• Full surgical recovery usually occurs within about 3 weeks