Laparoscopic RNY Gastric Bypass vs LAP-BAND Laparoscopic RNY Gastric Bypass still comprises over 80% of all weight loss operations in the United States for good reasons, and is predominant in the best medical centers. LAP-BAND, on the other hand, was given to only the most respected bariatric surgeons in this country by the FDA to trial around 2000. Despite receiving FDA approval in 2001 it has been rejected almost universally by those American experts in favor of gastric bypass because of unacceptable long term results. Furthermore, surgeons in Europe who have “banded” for over a decade (almost universally) are starting to do gastric bypass preferentially, or as “rescue or revision” operations on their failed LAP-BAND patients. Nevertheless, LAP-BAND is an easy operation to perform, with few early complications associated with the operation itself. As such, it is very popular with surgeons starting to do bariatric surgery, and has led to alarmist and sometimes absurd references to outdated and antiquated data about gastric bypass in order for those surgeons to promote the LAP-BAND. No mention is made by those surgeons of the poor weight loss results, and the more alarming long-term complications associated with LAP-BAND.
An ideal operation should accomplish two goals:
- Provide optimal weight loss.
- Allow for normal eating habits and lifestyle indefinitely.
FACTS AND MYTHS
THE OPERATION
FACT:
Laparoscopic RNY Gastric Bypass is a difficult operation to perform safely and may require the experience of 100 operations for a surgeon to attain excellence – but that goal can be accomplished. One simply needs to search for an experienced surgeon performing laparoscopic gastric bypass.
-Schauer, P. et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.
Surgical Endoscopy. Vol. 17, 2003
LAP-BAND is easy to perform and is therefore a “safe” operation.
WEIGHT LOSS MYTH:
LAP-BAND is “as effective for weight loss as Laparoscopic RNY Gastric Bypass”.
FACT:
Six of the best bariatric centers in the country doing Laparoscopic Gastric Bypass have demonstrated “excess body weight loss” (EBWL) of 69 to 84% at one year. We have averaged 82% EBWL at one year in almost 200 patients, and many of our patients reach “ideal body weight”.
Most reports of weight loss with LAP-BAND range from 45 to 55% EBWL, with one of the best reports coming from Australia at 57%—that took six years to attain. Many experts believe that almost 50% of LAP-BAND patients have less than 50% EBWL (generally regarded as a surgical failure).
With LAP-BAND “… weight loss was insufficient in slightly over 40% of the patients…”
-Suter, M., et al. Laparoscopic Gastric Banding: A prospective randomized study…
Annals of Surgery, January, 2005.
A comparison of weight loss with bypass and banding, respectively, in 1200 patients showed EBWL “… 74.6% versus 40.4% at 18 months…”.
-Gagner, M. Laparoscopic Gastric Bypass versus Laparoscopic Adjustable Gastric Banding: A Comparative Study of 1200 Cases.
Journal of the American College of Surgeons, October, 2003.
RISK OF DEATH FROM OPERATION MYTH:
LAP-BAND is much safer than Laparoscopic RNY Gastric Bypass.
FACT:
The mortality rate with LAP-BAND is boasted to be about 0.05%. Mortality rate from recent data at six reputable centers doing Laparoscopic Gastric Bypass (including ours) which comprised a total of 2389 patients was 0.08%. This difference is not even statistically significant!
RISK OF COMPLICATIONS FROM SURGERY MYTH:
LAP-BAND has fewer complications than Laparoscopic Gastric Bypass.
FACT:
The 1200 patient comparative study showed an “early complication rate” (first week after operation) of 4.2% with bypass and 1.7% with banding. “Late complications” (the first 18 months after operation) occurred in 8.1% with bypass and 9.1% with banding. Beyond this time, however, bypass patients will have almost none, while the band patients, with the foreign body in place, will see inexorable progression of complications over time.
One “estimate of the failure rate (from complications with bands) indicates that removal is expected in almost one out of ten patients every year”.
-Scopinaro, N., et al. Thirteen Years of Follow-up in Patients with Adjustable Silicone Gastric Banding for Obesity: Weight Loss and Constant Rate of Late Specific Complications.
Obesity Surgery, Volume 14, 2004.
In another scientific surgical report there were 44% “late complications in 103 patients…20% had to be converted to gastric bypass…”.
-Weber, M., et al. Laparoscopic Gastric Bypass is Superior to Laparoscopic Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery, December, 2004.
“Increasing experience with LAGB (bands) has shown a high incidence of long-term failure and complications…15-58% of the cases. Most of these complications require reexploration.”
“ As more than 70,000 patients worldwide have received a gastric banding over the past decades, it can be predicted that many patients will require ‘rescue’ or revision operations.”
-Mognol, P. et al. Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: A review of 70 patients. Obesity Surgery. Vol. 14, 2004.
“… increasing experience with laparoscopic gastric banding (LAP-BAND) has shown a high incidence of long term failure…it can be predicted that we will see many patients requiring rescue procedures…”
-Clavien, P. et al. Laparoscopic Roux-en-Y Gastric Bypass, but Not Re-banding, Should Be Proposed as Rescue Procedure for Patients with Failed Laparoscopic Gastric Banding.
Annals of Surgery. December, 2003.
REVERSIBILITY MYTH:
LAP-BAND is reversible. (As though the other operations were not!)
FACT:
If one could conjure up a scenario why a weight loss operation would have to be reversed, laparoscopic gastric bypass could be reversed with a laparoscopic procedure at many institutions with a two day hospitalization and one week recovery.
Why would you tout a treatment for a lifelong disease such as obesity as having the benefit of being temporary, unless you knew it would have to be temporary? Obesity would return rapidly. A good operation should be done “for life”, and provide normal eating patterns and normal quality of life. Thousands of patients are now twenty years out from their Roux-en-Y gastric bypass with no problems, whatsoever.
LONG TERM WEIGHT LOSS MAINTENANCE MYTH:
With RNY you will regain your weight.
FACT:
It has been documented with long term follow-up that weight loss remains excellent over five years after the operation.
-MacLean, L., et al. Late Outcome of Isolated Gastric Bypass.
Annals of Surgery. April, 2000.
For copies of the complete text of these surgical studies please contact our office and they can be mailed to you.
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