Members of DS over the years have asked about the various weight loss surgeries. Specifically, the Lap-Band seems to be what most people hear about. Here are the basics and several discussions over the years on the Gastric Bypass Community cover this in more detail.

So, you’ve decided to pursue weight loss surgery (Bariatric Surgery): For patients with a Body Mass Index (BMI) of 40 or above who have failed diet and exercise (with or without drug therapy) or for patients with BMI greater than 35 and obesity-related co-morbidities (hypertension, impaired glucose tolerance, diabetes mellitus, dyslipidemia, sleep apnea), bariatric surgery is an accepted option and covered by most insurance plans.

What is the Lap-Band I hear so much about?
Laparoscopic gastric banding or lap banding, is a procedure that compartmentalizes the upper stomach by placing a silicone band around the entrance to the stomach. This procedure is done laparoscopically, which means that small incisions are made and a tiny camera is inserted (so this is done without cutting open the abdomen). The band is connected to a narrow tube that extends to an access port just beneath the skin and a healthcare provider can narrow or widen the entrance to the stomach by injection or removal of saline through the port. The passage of food from the upper pouch to the rest of the stomach is delayed so the patient feels full after eating less.

Why is the Lap-Band so popular?
The Lap-Band is a popular choice of weight-loss surgery because it is relatively simple to perform and can be adjusted or removed.


Does the Lap-Band work as well as the Roux-en-Y Gastric Bypass Procedure? No, and some disappointing results seen after 10 years were reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery, October 20, 2008 



Here are some details: 


1) Failure with laparoscopic adjustable gastric banding occurred in nearly HALF OF ALL patients who received the procedure during 10 years of follow-up, according to a review of a consecutive series of patients at one center.



2) One study reported that 374 (44%) of 841 patients who underwent the procedure during 1995-2005 failed the treatment.



3) THESE FAILURES INCLUDED 124 patients who lost less than 25% of their excess weight and 250 patients who had their band removed (134 with removal alone, 115 with conversion to gastric bypass, 1 with conversion to sleeve gastrectomy).

4) Follow-up data were available for about 90% of the patients at 8 and 10 years after surgery. Among patients who had a band in place, the mean percentage of excess weight loss reached a PLATEAU at 2 years at 44% with a mean BMI of 37 kg/m2. At the end of 10 years of follow-up, 577 patients who still had a gastric band in place had lost a mean of ONLY 22% of their excess weight.

What is the ideal Gastric Bypass Procedure? This can be determined when a good Bariatric Surgeon evaluates you but the Roux-en-Y Gastric Bypass (RYGB) can be safely performed laparoscopically in well-trained hands, and in my experience this procedure produces the best results. Laparoscopic RYGB provides several advantages such as lower incidence of incisional hernia, wound infection, faster recovery, and a shorter hospital stay. Although the procedure can be limited by patient size, instrument and trocar length, even the extremely large patients have been successfully operated laparoscopically

Dr. Orrange