Comparison Adjustable Gastric Banding/Bypass

Comparison of Gastric Bypass vs. Adjustable Gastric Band

Most of our patients are likely to achieve weight and health success with either the Gastric Bypass or the Adjustable Gastric Band. In such cases, the question naturally comes from the patient: “Should I have the Gastric Bypass or Gastric Band?”

After extensive discussion and consideration, the bariatric surgical community has realized that we just don’t know which procedure is best for every patient. In other words, there is no test or set of questions that tells us which procedure fits best with which patient. We find it works well to teach patients about all their options, and then in most cases the patient should be the one to decide the type of surgery they will undergo.

Comparison of Gastric Bypass and Adjustable Gastric Band

Roux-en-Y Gastric Bypass

→ Gold standard, time tested since early 1980’s.
→ Complex operation, multiple areas of abdomen involved
→ Rapid weight loss over three to six months, settling at final weight about 10 to 16 months after surgery
→ Decreased mineral absorption, requiring long-term supplements such as Iron, Calcium, B12
→ Dumping syndrome (intolerance to sugars and some carbohydrates)
→ Not reversible
→ No significant hardware in body
→ Reliable and sustained weight loss

Gastric Band

→ Medical data available since late 1990’s. Lifetime impact seems positive but awaits 20 year results.
→ Simpler operation, gives lower risk around surgery (less chance of death or prolonged hospitalization)
→ Slow and steady weight loss, settling at final weight around two years after surgery
→ Amount of weight loss usually less than gastric bypass or sleeve, and somewhat variable
→ Possible deficiencies due to decreased intake, long-term supplements also recommended
→ No Dumping syndrome
→ Sort of reversible
→ Long term (non-reactive) plastic material in body
→ The Band must be adjusted for best success

There are a few medical situations where a patient usually should not undergo Gastric Band surgery:
 

•     severe GERD or problems with esophagus function
•     prior surgery on the stomach itself (surgery on other parts of the abdomen is okay)
•     home located more than three hours drive from the surgeon – the Band needs close follow-up and surgeon access

If a patient has Diabetes or a condition called Metabolic Syndrome, we lean a bit toward Gastric Bypass because it causes some beneficial hormone changes in the abdomen that counterbalance the damaging effects of Diabetes or Metabolic Syndrome. It is common for us to bring our Diabetic patients into the hospital on high dose insulin, and if they undergo Gastric Bypass they are likely to be off all diabetic medications within a week. On the other hand, we know that Diabetes can improve with weight loss, so if a patient with Diabetes can’t become comfortable with the Gastric Bypass then we still feel comfortable offering the Band.

There are a couple of situations where the Band can be a bit more appealing than the Gastric Bypass:
 

•     for the elderly – since the Band is a lower impact procedure it may get frail patients through surgery with less risk
•     for patients who do not require massive weight loss