My spouse weighs approx. 500lb and it's hard for her to exercise to get the weight off, so we're looking into weight loss surgery to help. What should we consider when choosing between gastric banding and gastric bypass? I'm concerned that gastric bypass is too drastic and permanent but she thinks the results are more dramatic. Thank you!
Gastric Bypass Vs. Gastric Band - How to Choose?
Doctor Answers 3
Gastric Bypass vs Lap Band
These are two completely different operations. The gastric bypass procedure is a restrictive and malabsorptive operation. With the proper nutritional counseling and behavior modification, you can get close to your ideal body weight. This operation can be performed and has excellent results in patients with a BMI >45 and those who have a metabolic condition such as diabetes. This operation can place diabetes in remission in almost 85 - 90 percent of cases and/or significantly decrease the need for medication.
The lap band can be an effective operation for the well motivated patient who will excercise routinely and follow good nutritional advice. The band is purely a restrictive procedure and does not change your absorptive capacity, therefore it is much less effective overall. The lap-band is best for patients in the BMI range of 35 to 45. Although patients with higher BMI numbers may be candidates for the band, these patients typically do not lose significant amount of weight (there are always exceptions).
The lap band has a lower risk profile than the bypass but it still has complications. It makes sense then that a procedure with a lower risk profile has typically less weight loss results as compared to one with a higher potential complication rate such as the gastric bypass.
Hope this helps!
Choice of operation for high BMI patient
I would recommend neither gastric bypass nor gastric band for a patient with a BMI above 60. Weight loss after gastric banding is unreliable at best; some patients don't lose weight at all. A patient in this high-risk category needs an operation which won't fail. Gastric bypass gives reasonable initial weight loss, but many patients in the high BMI category don't lose enough weight, or regain after a few years. Such patients should consider a more powerful operation such as vertical sleeve gastrectomy with biliopancreatic diversion and duodenal switch. Another option would be to just have the sleeve gastrectomy. The patient could then have the option to later add the malabsorptive component if they are unhappy with their weight loss. This is option I recommend to most of my patients.
Gastric Bypass vs. Lapband
The decision is a personal choice. Gastric bypass has greater risk at the initial operation. It is important to discuss the risks, benefits, and results of both before making a decision.
Shawn Garber, MD FACS
The New York Bariatric Group