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July 18, 2006

Gastric Bypass Might Be Better Than Lap-Band

Lapband Extremely obese patients undergoing weight-loss surgery may do better with a procedure that bypasses part of the intestine rather undergoing a banding procedure that creates a small pouch in the stomach, according to a new study released Monday.

Researchers at the State University of New York, Health Science Center of Brooklyn and Lutheran Medical Center, also in Brooklyn, N.Y., looked at two commonly performed types of bariatric surgery in 106 patients who underwent the procedures between February 2001 and June 2004. The study appears in the July edition of the Archives of Surgery.

Sixty patients received a so-called Lap-Band device through a laparoscopic procedure which allows surgeons - through a small incision near the stomach - to place a silicone band around the stomach dividing it into two smaller compartments. The device is designed to restrict food intake and make patients feel full sooner than those with a full-sized stomach.

Forty-three patients underwent another type of procedure known as the laparoscopic Roux-en-Y Gastric Bypass, which involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions, reducing the amount of calories absorbed by the body from food.

Overall, researchers found patients undergoing the laparoscopic bypass surgery had fewer long-term complications, lost more weight and had larger improvements in other co-morbidities, such as high blood pressure and diabetes, than patients who underwent the lap-band procedure.

The better outcomes of patients undergoing the bypass procedure is likely the result of better compliance among those patients rather than a particular problem with the lap-band. He said the lap-band can allow patients to cheat and consume more calories through liquids because they can still pass fairly easily through the small stomach.

For the band to be successful it requires significant will power, discipline and compliance.

Patients in the study were considered "super" morbidly obese and had body mass indexes of 50 or greater. On average patients in the study weighed roughly 340 pounds before surgery.

Patients undergoing the lap-band procedure were hospitalized for less time with an average of 1.8 days compared with 3.5 days for patients undergoing the bypass procedure. Short-term complications were statistically similar between the two groups.

However, long-term complications, or those that occurred after 30 days or longer, were more common in the lap-band group with 78% of patients experiencing complications compared to 28% in the bypass group. The most common long-term complication was vomiting and dehydration.

The study also showed that 15 patients with the lap-band needed follow up surgery compared to three in the bypass group. The lap-band can be adjusted after initial surgery to be made larger or smaller. Patients in the study were followed for an average of 16.2 months.

Patients who underwent the bypass had an average BMI decrease of 26.5 compared with 9.8 in the lap-band group, however researchers said both procedures produced "satisfactory" amounts of weight loss.

All patients reported fewer co-morbidities after surgery, but the decrease was more pronounced in gastric bypass patients. For example, rates of diabetes dropped to zero from 17.4% before surgery in the bypass group. Rates of diabetes in the lap-band group fell to 11% from 18.3% before surgery.

The typical gastric surgery patient has a pre-surgery BMI of 40. Some patients with BMIs of 35 or more are also considered good surgery candidates if they have another problem linked to being overweight like diabetes.

Although the study focused on patients with BMIs of 50 or greater, patients do better with a bypass rather than a lap-band. However, not every patient is a good candidate for a gastric bypass - for instance, those with certain liver problems, as well as those who've had stomach ulcers - and they might need a lap-band or similar device.

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Comments

Susan F.

I'm pre-op and am reading with interest many articles like these that fail to mention two of my MAJOR concerns: long-term maintenance of weight loss and any long-term malabsorbtion affects. This study also doesn't address this. I find the quick weight loss with apparent ease very attractive - as would anyone. But GBP doesn't teach me how to eat or reduce my portions. When discussing these issues with a prospective surgeon, he admitted to me that some GBP patients lose too quickly and don't learn how to eat again...thereby, they need a "crash course" on eating when they begin to gain weight. (This spoke to me as, unbeknownst to him, he was describing me.)

I just think for me, the Band gives me slower weight loss and the long term restriction (versus malabsorption) and the change of life-style better serves me than GBP. Thank goodness we have a choice!

Tamara Shaw

When ever I check out weight loss surgery boards, I ALWAYS check out the site for those who have passed away due to surgery complications. Funny thing is....I've only seen 1 from Lap Band. Very few for the DS or the VSG. Which means one thing. All those other hundreds of names of people who have died were Gastric Bypass Patients.

And even tho not every surgery is good for every person, I happen to personally know 4 gastric bypass patients who now have a Lap Band on their stomas. And the Lap Band board that I frequent is full of Gastric Bypass patients who have had to have the Band put on.

As for all medical journals and other so called medical studies, I find it's better to get "real world" advice from those who have actually gotten the surgery in question. That is where you find the most unbiased results.

Let's face it. I would never to a toyota dealership to buy a chevy. Why would I go to a surgeon who only practices one type of weight loss surgery.

If anyone is seriously considering having weight loss surgery, I would recommend that their research include talking to those who have had weight loss surgery and seeing a surgeon who does all surgeries. Between research and talking to your doctor, the two of you can decide which surgery is best for YOU. Not which is the cheapest or the quickest. After all you didn't gain 100 lbs in 6 months. Why should you have to lose 100 lbs in 6 months?

Dena Waskiewicz

I chose RNY for me because it offered me the best lifestyle changes. I needed malabsorption and the potential for dumping syndrome, whether I get it or not, as well as restriction. RNY offered all of that, but the band did not. That's how I made my decision. I, too, know people who have had other types of WLS, band included, who are miserable and wish they had chosen another type of WLS. I've seen successes in all types of WLS. More power to someone who makes their tool work for them. For me, I chose RNY and I'm glad that I did -- it is perfect for MY lifestyle. I did not think the band would offer me what I needed, and the ability to still cheat right past the band was major for me. I am learning portion control and foods to stay away from for the rest of my life. That's part of a great nutrition followup that my program requires. I think people who don't learn the skills it takes to work their tool probably never got appropriate nutritionist support -- that's a failure of their program, not a failure of their tool. It pays to do some research preop and find a program that is going to help you learn the proper way to work your tool rather than here's my money, do my surgery, and set me free to sabotage myself. Just my 2 cents' worth!

Julie -100lbs

Sounds like a pretty bogus study to me.

http://www.obesityhelp.com/forums/lapband/board_id,5359/cat_id,4959/topic_id,3263177/a,messageboard/action,replies/#25200931

Julie -100lbs

What kind of study involves 106 ppl over 4 yrs? Sounds like the doctor had an agenda.

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