Medical Assistant – Gastric Bypass vs. The Lap Band
There has been increased media attention on the epidemic of obesity in America, yet the number of individuals carrying excess weight has continued to rise since 1960. It is estimated that 68 percent of Americans are currently overweight or obese. Obesity is the term used to describe anyone 20 percent or more over a normal weight range (or body mass index of 30) for their age and height. Morbid obesity means you are carrying 100 pounds more than normal or have a body mass index (BMI) of 40 or higher. In addition to adults, there are an estimated twelve and a half million children between the ages of 2-19 currently overweight. Children, as young as 10, are beginning to show signs of metabolic syndrome, high blood pressure, high cholesterol, and Type 2 (adult onset) diabetes.
Most people are aware that excess weight increases the risk of heart disease, high blood pressure, diabetes and other conditions. Other effects of excess weight are not commonly known. These include increased risk of Parkinson’s disease, asthma, fertility problems, and pregnancy complications. The good news is that you do not have to lose all your excess weight to see great improvements in lowering these health risks. Experts agree that as little as a 10 percent weight loss will decrease health risks and make managing any medical conditions easier.
A traditional recommendation to eat less and get more exercise remains the best way to lose weight. Today’s hurried lifestyles and increased technology that keeps us tied to computer screens presents a challenge to taking time to fix healthy balanced meals and getting daily exercise on a consistent basis. As with the understanding that a small percent of weight loss offers increased health benefits, small lifestyle changes involving food choices and activity can lead to big changes that result in consistent weight loss. Something as simple as eating smaller portions of your normal food choices and taking a 10-15 minute walk per day can go a long way to improving your health. Weight loss through dietary changes and exercise should be the first choice to improving your health. Only after consistent attempts to lose weight through traditional methods fail should weight loss surgery be a consideration. Weight loss surgery is not a “quick fix.” To be considered for bariatric (weight loss) surgery you must understand that following surgery you will need to restrict food choices and portions and exercise regularly to lose the most weight and maintain the weight lost within the first year. Individuals unwilling or unable to commit to the complete lifestyle changes that bariatric surgery requires will seldom maintain their weight loss following surgery.
All bariatric surgery candidates are required to complete an extensive screening process to determine their willingness and ability to follow dietary and exercise recommendations before and after surgery, and that they are emotionally and mentally ready to face the challenges of the complete lifestyle change required for bariatric surgery to be a success. Bariatric surgery should be a consideration only after you and your doctor have determined that there are no other choices. If you are considering surgery, take time to educate yourself concerning the procedures and steps needed to lose weight and maintain an active healthy lifestyle after weight loss. For those considering bariatric surgery as an option to lose weight, gastric bypass, and gastric lap banding are the two most commonly used procedures.
Gastric Bypass Surgery
Originally, gastric bypass involved removing part of the stomach (biliopancreatic diversion bypass) now there is a less complicated procedure known as Roux-en-Y-gastric bypass that is most often used. This procedure has less risk of complications because no portion of the stomach is removed decreasing the risk of nutritional deficiencies associated with the biliopancreatic procedure. In gastric bypass, the size of the stomach is reduced to a small pouch. A part of the small intestine is then rerouted in a y-shaped connection that causes the food to bypass the jejunum, which is the middle of the small intestine responsible in part for food absorption. The y-shaped bypass promotes weight loss by decreasing food absorption and reducing hunger. Gastric bypass surgery is complicated and takes between 2-4 hours. A newer procedure allows the bypass to be done laparoscopically which lessens scarring and reduces recovery time, but is not yet widely available. With a successful gastric bypass, weight loss is ongoing for one year and may continue at a slower rate for the second year.
You will spend several days in the hospital, following gastric bypass surgery, and you will be advised to restrict activities for up to five weeks or more during your recovery progress. Gastric bypass is major surgery with abdominal bloating, tenderness, and discomfort for part of the post-surgery period. Your doctor will monitor your progress and prescribe medications, but it is important that you- do not take anything for pain or any other medications or supplements without consulting with your doctor – as doing so can be dangerous. Your doctor will closely monitor your progress weekly at first then monthly and semi-monthly throughout at least the first year. During that year, you will be given a dietary plan, exercise recommendations, therapy to assist in behavior modifications, and a list of nutritional supplements to be taken daily. After a year of weight loss, plastic surgery may be required to remove excess skin.
Few weight loss candidates lose 100 percent of their excess weight. Successful bariatric surgery is achieving a 60-70 percent weight loss that is maintained for 5 years or more. As noted earlier, how you commit to a complete lifestyle change following any bariatric surgery greatly influences the outcome and success for maintaining weight lost during that first year. Communicate any difficulties or concerns to your doctor immediately. To assist you in being successful, you doctor may recommend closely working with a special nutritionist, behavioral therapist, and physical therapist during your first year following surgery.
Lap Band (Gastric banding) Surgery
* Though gastric banding and lap banding are often used interchangeably, Lap Band® is a registered trademark name for the original adjustable device sold and manufactured by Allergan, Inc.
While most gastric bypass operations are done with open surgery procedures requiring cutting through to the stomach and small intestines, lap band surgery is always done laparoscopically. This makes the lap band procedure safer in terms of reducing surgical risks. During laparoscopic surgery, several small incisions are made allowing the insertion of long thin instruments to implant the banding devise. The gastric band is positioned around the upper part of the stomach and is designed to be adjusted by using a port to inject or withdraw saline. There is no cutting or stapling done during most banding procedures and average surgery time is about one hour and is often done on an outpatient basis.
Gastric banding has less surgical risks than traditional gastric bypass but weight loss is often slower. Like gastric bypass surgery, gastric banding still carries risk of infection, blood clots, or breathing difficulties. Success rates vary with some reports claiming gastric banding failures widely ranging between 5- 37 percent. Failed gastric band surgery involves failure to lose weight or complications requiring removal of the gastric band. Complications requiring band removal include infection; the band grows into the stomach (erosion or band migration), ongoing discomfort, nausea or vomiting (intolerance), or band slippage with the stomach slipping out of the band resulting in a larger stomach pouch. Surgeon technique and the facilities where gastric banding is done appear to be related to success or failure rates. Ask your surgeon about their rate of success and do not hesitate to “comparison shop” before making your decision.
Even under the best situations and with top-notch surgeons, sometimes band failure will still occur. If so, the options are to replace the band or have an alternate gastric bypass procedure. According to studies, those patients who have gastric bypass after a failed gastric band have a greater success rate than patients who replace a failed band with another banding procedure. As many as 45 percent of gastric band patients need follow-up surgeries, this drops to 20 percent for patients replacing a failed band with gastric bypass.
Gastric Surgery Complications
Surgery of any type involves risks. With bariatric surgery, you and your doctor decide if the risk of remaining obese is potentially more dangerous than surgery. However, while weight loss surgery is done to reduce weight and decrease ongoing health risks; excess weight increases the risk for any surgery including bariatric surgery. The more excess weight you have at the time of surgery, the greater your chance of complications. For this reason, some bariatric surgeons will requires you to follow a pre-surgical plan of dieting and exercise with the goal to lose weight before surgery is scheduled. Successfully following such a pre-surgery plan greatly increases your chance to successfully lose weight and maintain weight following your surgery.
Potential gastric surgery complications include leaks from the connections made during surgery that allows digestive fluids to leak into the abdominal cavity causing infection (anastomotic leaks). These leaks occur in approximately five percent of gastric bypass patients. Your surgeon will check connections several times before finishing your gastric bypass to prevent leaks. Surgery may be required to repair leaks that do not respond to resting the stomach by withholding food and water and using IV therapy during that time.
Blood clots traveling to the lungs (pulmonary embolisms) are a complication possibility with any surgery, including laparoscopic surgery. Getting active as soon after surgery as possible, the use of blood thinners, and not smoking for at least six weeks prior to surgery can decrease your risk of post-surgical blood clots. Smoking not only increases your risk of blood clots after surgery but also increases your risk of ulceration after laparoscopic surgery. If you or any family members have a history of blood clots, be sure to make your doctor aware of this as this too increases your risk of pulmonary embolisms. Blood clots can also lead to respiratory failure and death.
Bariatric surgery can help you lose weight and improve your quality of life when all other attempts at weight loss have failed. Be informed and consider your options before deciding if weight loss surgery is your best option. The following resource links may help you consider the benefits and risks involved before making your decision.
- University of Maryland Medical Center, Gastric Bypass Surgery – On this site, you will find an overview of gastric bypass surgery, risks, and recovery information. By clicking on the Main Menu tab in the purple band, you can start at Step one for a complete look at Understanding morbid obesity and the steps leading to and following gastric bypass surgery.
- Dietary Recommendations following Gastric Bypass Surgery (PDF) –The University of Mississippi Medical Center published this document as a guideline for gastric bypass patients to follow post-surgery. Use this for educational/ informational purposes but if you have had or are considering gastric bypass always follow the advice of your doctor and nutritionists as there may be variations based on your individual needs.
- Type 2 Diabetics Need to monitor Blood Sugar closely following Gastric Bypass Surgery – Some patients with Type 2 diabetes requiring insulin find they may leave the hospital without needing medication. For others, they may experience abnormally low blood sugar levels requiring prompt treatment. Check this article for more information.
- Types of Bariatric (Weight Loss) Surgery – There are three categories of bariatric surgery, malabsorptive procedures, restrictive procedures and combination procedures. Before you and your doctor can decide which is right for you check out the comparisons of all three procedures found on this website. This website also features successful patient testimonies in a sidebar to the right of the page.
- Personal Success Story: Lisa G. Before and After Gastric Bypass – At over 500 pounds, for Lisa G. a gastric bypass was a matter of life or death. Her success story shows that the surgery itself is only the first step through a process requiring a commitment to a completely new lifestyle of eating and exercise. Today she is a fitness trainer and you can read more here about her incredible journey to a new life.
- Commonly asked Questions about Bariatric Surgery – Though these questions were answered as part of the patient information provided to weight loss patients at the University of Chicago Medical Center, the questions and answers are those all individuals considering gastric bypass or lap-banding surgery will need to answer before making their decision.
- A Comparison of Bariatric Surgeries – On this Ohio State University Bariatric Surgery site, you will find a chart that offers side-by-side comparison to the three bariatric procedures offered there. The three procedures are the Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Gastric Banding.
- Overview: Lap-Band ® Surgery – (University of Michigan Adult Bariatric Surgery Program) Here on this page, you can see a diagram of the adjustable lap band and where it is placed during surgery. This covers deciding if you are a candidate for this type surgery, the educational phase of learning what to expect, pre-op procedures, the surgical procedure as well as the post-op phase and need to monitor your progress. You can also read about two success stories and view their before and after picture on this site.
- Is Bariatric Surgery Effective and Safe for Teens? – This report addresses the questions surrounding the effectiveness and safety of bariatric surgeries for adolescents. Latest studies show lap-band surgery may be better for adolescents than gastric bypass, but there remains conflict wither teens should be considered for gastric bypass or gastric banding at all. For more information read here and weigh the options for yourself.
- Video: Watch Me Get Skinny – This gastric bypass recipient shares his journey of weight loss following gastric bypass surgery. Within his video series on YouTube, he shares the struggles, and questions he encounters on the way to losing weight. This video is a slideshow of his weight loss from post-surgery through the first year. Amazing!
- The Risks of Bariatric Surgery from a Surgeon’s Perspective – Dr. G. Wesley Clark, is a bariatric surgeon who originated the laparoscopic gastric bypass procedure. In this article, he clarifies the way statistical numbers may not give a true report, while at the same time expresses his understandings of the risks involved in bariatric surgery.
- Gastric Bypass Risks – As with any major surgery, there are risks involved. Before you agree to any type of surgery, you should be informed of what those risks are. Here is a listing of risks involved in gastric bypass surgery. Ask your doctor if you have any questions not covered here.
- Lap Band Risks and Complications – This site explores the risks and complications of lap band weight loss surgery. Other helpful information found on this site includes a “doctor locator” by state, an “Ask the Doctor” forum, information concerning the cost of lap band surgery, postoperative recovery information.
- How to Avoid Lap Band Surgery Failure – According to information on this page, anywhere from five to thirty-seven percent of lap band patients will experience failure. A failed lap band surgery is defined in two ways, not losing weight, or complications requiring removal of the band. Read the full report here to see how to reduce your risk of lap band failure.
- Lap Band Success Stories – These testimonies of lap band success stories are on the official site for the manufacturers of the Lap Band®, the success stories include before and after pictures. Information on the Lap Band® and other weight loss options can be found under the Compare Lap Band® to Other Weight Loss Options section.
- Study reveals real Weight of Risks Following Lap Band Surgery – According to this report on ABC News/Health, nearly half of those having lap band bariatric surgery will have serious complications that require additional surgery to remove the bands.
- Lap Band Surgery May be Best Option for Morbidly Obese Children - Surgeons at the Children’s National Medical Center recently published a report that supported using adjustable gastric banding to treat morbid obesity in adolescents. According to this report, following lap band surgeries, adolescents showed improvement in android fat levels, reduced insulin resistance, and no loss of bone mineral density.
- Need Financial Help for Weight Loss Surgery? – The Weight Loss Surgery Foundation of America (WLSFA) is a cooperative effort between weight loss patients, surgeons, hospitals and corporations working to assist those needing weight loss surgeries in finding funds to cover the expenses. The WLSFA is a non-profit organization and always appreciates volunteers and donations.
- An Illustrated Guide to Weight Loss Surgery – WebMD presents an illustrated guide to bariatric surgery that takes you through the procedures via a slide show and videos. Other information concerning weight loss surgery, pros, and cons can be found following additional links on this site.