Lap Band vs. Gastric Bypass: Choosing the Right Procedure For You

By Ajay Goyal, MD, FACS, New Jersey Bariatric Center

LAP BAND	GASTRIC BYPASS
Less Invasive	More invasive
Reversible	Irreversible
Adjustable	Not Adjustable
Slower weight loss	Faster weight loss
More Follow up	Less Follow up
More Dietary compliance required	Less Dietary compliance required

GASTRIC BYPASS OR LAP BAND?

Patients considering weight loss surgery often ask “which procedure is right for me?” At the New Jersey Bariatric Center both surgical weight loss procedures -- gastric bypass or lap band -- result in successful weight loss. The best way to make the decision regarding which procedure is best for you is to consider several factors: loss of pounds, reversibility, diet requirements and risk, and compare the pros and cons of them against your personal goals.

Weight loss:
Initial weight loss with the gastric bypass is approximately 3lbs to 5lbs per week for the first three to six months. Over 18 months the gastric bypass procedure results in approximately 60 to 70 percent excess weight loss. However, gastric bypass is both a restrictive (restricts the intake of food) and mal-absorptive (less absorption of calories you take in) procedure resulting in weight loss from both decreased food intake and decrease calorie absorption.

With the lap band procedure weight loss is slower, about 1lbs to 2lbs a week. Over an18 months it will approximately result in a 50-60% excess weight loss. Since the Lap Band is only restrictive, and not mal-absorptive, it requires much more personal will power to avoid high calories and snacking. In addition, Lap Band requires significant and consistent follow up for the first year to adjust the band.

Keep in mind, that a slower weight loss does not necessarily mean less ‘hanging skin,’ nor does faster weight loss result in more ‘hanging skin’ problems. These issues are a factor of the amount of weight loss and your age, not the amount of time it takes to lose the weight.

Reversible:
Unlike the gastric bypass, the lap band procedure is reversible. At any time, you can choose to have the band removed. Keep in mind, patients who typically have the band removed often gain the weight back over a short time period.

Diet:
Regardless of the procedure, patients are required to eat healthy and exercise to maintain the weight loss. However, when comparing the procedures, the gastric bypass requires less dietary compliance as it combines both the restrictive and mal-absorptive components. With the bypass you simply can’t intake the same amount of food, high caloric food or eat to quickly without getting physically ill (dumping syndrome). However, due to the mal-absorption component of the bypass, patients must take protein and vitamin supplements for life.
Dumping syndrome can occur after gastric bypass surgery resulting in dizziness and heart palpitations. It occurs 15 to 30 minutes after a high carbohydrate meal, especially one that's rich in sugars such as sucrose (table sugar) or fructose (fruit sugar). Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream.

Risk:
To date, at the New Jersey Bariatric Center we have no mortality and below average complications for both procedures. However, when comparing the two procedures and looking at the national statistics the lap band has a significantly lower risk of death than the gastric bypass procedure since it is less invasive.

Making the decision:
Ultimately, the decision to have the procedure is entirely up to you. After reviewing all the information and attending one of the free educational seminars at New Jersey Bariatric Center, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

While most patients enjoy an improvement in obesity-related health conditions (such as diabetes, heart disease, mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer.
The key is not to be pressured to pick a procedure by anyone, including your medical doctor, your family or a friend. Do the research yourself and learn the pros and cons of both the procedures. In the end, the decision is yours, it’s your life and you will need to be comfortable with what you choose.