Which is better gastric bypass or lap band?
What is the safest form of weight loss surgery?
Is better lap band or gastric sleeve?
What is the safest form of weight loss surgery?
Individuals who are considering bariatric surgery for weight loss have multiple options. From traditional gastric bypass surgery to lap band surgery to gastric sleeve, each type of surgery has its own benefits and risks.
When deciding which surgery is right for you, it is essential to compare your options. You should understand the similarities and differences between the two types of bariatric procedures. When reviewing Lap Band vs Gastric Sleeve,
there are a number of factors to consider:
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Lap Band vs. Gastric Sleeve: The Similarities and Differences
Sleeve gastrectomy and lap band surgery both involve modifying the stomach so that it can hold less food. However, they go about this in very different ways.
The lap band is a device that goes around the stomach, cinching off a pouch that holds a small fraction of the food that the whole stomach can normally contain. It is “inflated” or “deflated” with saline injections via a small port beneath the skin. There is no cutting or stapling of the stomach in lap-band surgery, and digestion takes place normally.
In the gastric sleeve operation, the surgeon actually removes a large part of the stomach. The remaining part of the patient’s stomach is in the shape of a tube, or sleeve. Because the sleeve gastrectomy involves cutting and suturing of the stomach, recovery time may be longer after this procedure than after the lap band. Although this is a more invasive procedure, it does have the benefit of generally providing superior weight loss in the first 12-18 months after surgery.
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Another difference between the procedures is the profile of the average patient.
The lap band is recommended by the Food and Drug Administration as a possible weight loss solution for people with body mass index as low as 30 in some cases.
Sleeve gastrectomy, on the other hand, is usually reserved for patients whose BMI are significantly higher. The average gastric sleeve patient is “morbidly obese,” which means that their BMI is over 40.
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Some studies have concluded that gastric sleeve surgery is also safe and effective for lower-BMI patients, as well.
The lap band involves no cutting or modification of the digestive organs, so it is completely reversible in the case of side effects. However, the patient should consider it permanent; if the lap band is removed, so is the weight-loss assistance it offers, and the patient risks putting the lost weight back on.
Sleeve gastrectomy, on the other hand, is not reversible, because the surgeon removes up to 80 percent of the stomach. The surgeon is unable to reattach the removed stomach portion after the fact.
Comparison between Lap Band and Gastric Sleeve Surgery
What is Gastric Sleeve Surgery?
Gastric Sleeve surgery also known as sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a weight-loss procedure that induces weight loss by restricting food intake. With this procedure, which is usually performed laparoscopically, the surgeon removes approximately 75-80 percent of the stomach. This results in the stomach taking on the shape of a tube or “sleeve” which holds much less food.
What is Lap Band Surgery?
Lap-Band, also known as Adjustable Gastric Banding (AGB), is an inflatable silicone ring implanted laparoscopically over the stomach to restrict food intake. Lap Band Surgery is a laparoscopic procedure that can stimulate restrictive weight loss surgery by placing a gastric band around the stomach.
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Comparing the procedure
How Gastric Sleeve is performed
Gastric sleeve surgery, also called the Vertical Sleeve Gastrectomy (VSG), is performed by removing a large portion of the stomach to create a long pouch that connects the esophagus to the small intestine. The pouch is stapled and the rest of the stomach is removed. Some surgeons take an additional step to reinforce the staple line, although whether that is effective is up for debate.
How Lap Band is performed
Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach using a laparoscope. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin of the abdomen. This port is used to introduce or remove saline into the band.
It is done using a laparoscopic technique. This involves making 3 to 5 small incisions, each about 1 inch in length. The surgeon inserts a small camera attached to a tube into one of these incisions and views the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band. The gastric band is placed around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.
LAGB ultimately restricts the size of the stomach and the amount of food it can hold. It also slows the passage of food to the intestine. By doing so, signals to the brain from the gut allow for a sensation of fullness and satiety with the consumption of less food. This signal is sent from a small pouch created by the band in the upper stomach. When the pouch fills, the same signal is sent to the brain that occurred previously when the entire stomach filled.
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Comparing the Advantages and Disadvantages
Gastric Sleeve Advantages:
. Can lead to significant weight loss (average of 66% of excess body weight)
. Can lead to significant improvement of obesity-related health conditions
. Doesn’t use a foreign object (like the gastric band) and doesn’t reroute the digestive tract (like the gastric bypass)
. Short hospital stays approximately 2 days and recovery time due to minimally invasive procedure
. Limits the amount of food that can be eaten
. Causes significant changes to digestive organs and hormones that result in reduced hunger and increased metabolism.
. Permanent (won’t need more surgeries or readjustments, like the gastric band)
Lap Band Advantages:
. Least invasive surgery for weight loss
. No intestinal rerouting; no cutting or stapling of the stomach wall or bowel
. Reduced patient pain, hospital length of stay and recovery time
. Low risk of nutritional deficiencies
. No risk of “dumping syndrome”
. Adjustable band allows the surgeon to customize how food flows from one part of the stomach to the other, which is ideal for long-term weight loss.
. Adjustments performed without additional surgery
. Approved for use during pregnancy
. Removable at any time (Lap Band is reversible); stomach generally restores to its original form.
. It does not change the digestive tract
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Gastric Sleeve Disadvantages:
. Requires lifelong dedication to specific diet and exercise routines
. Permanent (cannot be reversed)
. Can lead to vitamin deficiencies
Lap Band Disadvantages:
. Weight loss tends to be less than with gastric sleeve or gastric bypass procedures.
. There is still the risk of postsurgical weight gain
. Additional adjustments procedures are required.
. Requires a foreign device to remain in the body
. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients.
. Can have mechanical problems with the band, tube or port in a small percentage of patients.
. Can result in dilation of the esophagus if the patient overeats
. Requires strict adherence to the postoperative diet and to postoperative follow-up visits.
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Comparing the Risks and Complications
Gastric Sleeve Risks and Complications:
. Leakage from the staple line – this is a rate but serious complication of the gastric sleeve surgery. The reported leak rate is between 0.7-3 percent. In Iran, we pay paramount attention to our surgical techniques to minimize all the complications.
. Stricture/stenosis – In the past, we had one stricture among our first 20 gastric sleeve procedures. We have not had any strictures within the past 5 years.
. Bleeding
. Blood Clot
. Heart Burn – This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.
. Nutrient or vitamin deficiency
. Weight Regain
After two years, about 1 out of every 20 gastric sleeve patients have gained back some weight from their low point.
At 5 years, the average gastric sleeve patient regains as much as 50% of the weight they lost. Just as bad, the more weight you gain back, the more likely your health problems are to return.
The reasons for weight regain?
. Consuming calories in liquid form, such as protein shakes, pureed foods, smoothies, etc. Your new sleeve stomach works by making you feel full sooner when you eat. Since liquids don’t make you feel as full as solid foods, you’ll eat more and gain weight if you get your calories from liquids instead of solids.
. Overeating or eating the wrong things. This can stretch out the smaller gastric sleeve stomachs over time which will allow you to eat more and gain unwanted weight.
Remember, gastric sleeve is one of the best tools for weight loss, but it is only a tool. To avoid weight regain, you’ll need to eat the right foods and make the right lifestyle choices.
. Sagging Skin
For most obese patients, the skin has been stretched out for so long to accommodate the extra weight that it has lost its elasticity. Gastric sleeve surgery causes most patients to lose a lot of weight very quickly, and your skin simply can’t keep up.
The extra skin may be embarrassing. It can also cause several issues ranging from minor to severe, including:
. Hard time getting dressed
. Uncomfortable to exercise
. Skin problems, such as rashes and infections
In some cases, patients manage sagging skin with body-contouring undergarments. In more serious cases, patients have plastic surgery to remove the excess skin.
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. Digestive Issues
About 1 in every 5 patients experience Gastroesophageal reflux disease (GERD) in the first 12 months. The good news is that this tends to be a shorter-term issue. After 3 years, the GERD rate drops to around 3% of patients.
Other potential digestive issues resulting from gastric sleeve surgery include:
. Indigestion (Dyspepsia)
. Gallstones
. Developing an intolerance to some food types
. Vomiting or nausea
. Vitamin deficiency
These digestive issues can often be addressed and fixed with diet and behavior changes.
Lap Band Risks and Complications:
There are some risks associated with having a lap band. These include the following:
. Some people have an adverse reaction to anesthesia, including allergic reactions, breathing problems, blood clots in the legs that may travel to the lungs (pulmonary embolism), blood loss, infection, and heart attack or stroke during or after surgery.
. Weight loss may be slower compared with other types of surgery
. The band can slip or have mechanical problems, or it may erode into the stomach, requiring removal.
. The port can shift, making additional surgery necessary. Between 15 and 60 percent of people are reported to need follow-up surgery.
. The individual needs to follow dietary recommendations with care, as overeating can lead to vomiting or dilation of the esophagus.
As with other types of weight loss surgery, Lap Band also carries these risks:
. Injury during surgery to the stomach, intestines or other abdominal organs
. Hernia
. Inflammation of the stomach lining (gastritis), heartburn, and stomach ulcers
. Wound infection
. Gastrointestinal scarring that can lead to bowel blockage
. Poorer nutrition as a result of the restricted food intake
Who is a good candidate?
Is a gastric sleeve right for me?
The minimum requirements to qualify for gastric sleeve surgery include:
. A body mass index (BMI) of 40 or more, OR
. A BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, and many others.
Patients who qualify for gastric sleeve surgery usually:
. Are at least 80 lbs (36 kg) overweight.
. Are between 18 and 75 years old
. Have a history of failed weight loss attempts (example: failed diets)
. Thoroughly understand that the procedure is just a tool; your long-term success requires you to make significant diet and lifestyle changes.
Is a Lap Band right for me?
In the past, guidelines recommended Lap band placement only if a person’s body mass index (BMI) was 35 or above. Some people with a BMI of 30–34.9 had surgery if there were other obesity-related problems, such as diabetes, hypertension, or sleep apnea. This was because of the high risk of complications.
Advances in surgical techniques, however, have improved the safety record of the procedure, and this recommendation is no longer in place.
A doctor may now recommend bariatric surgery for some individuals with a BMI of 30–35 if:
. They have obesity-related complications and
. Non-surgical approaches have not proven effective
How long does each procedure take?
Gastric sleeve
The operation can take between one and two hours, but this may vary between surgeons.
Lap Band
The operation can take between one and two hours, but this may vary between surgeons.
What can I expect during recovery?
Gastric sleeve
During your gastric sleeve recovery, you can expect:
.Timeline: 4 to 6 weeks to full recovery
. Hospital Stay: 2 to 3 days
. Time Off Work: 1 to 3 weeks
. Pain: Same as experienced after any laparoscopic surgery, managed with medication
. Diet: Slow transition from clear liquids to solid foods
. Activity: Slow transition back to regular activity and exercise
. Challenges: Most side effects like nausea, digestive issues, and body changes go away over time or after adjusting diet/lifestyle habits.
Lap Band
Your Lap Band recovery will include:
. Hospital Stay: you will be there for 1 day or less
. Time off Work: you will need 1 to 2 weeks off of work
. Full Recovery: you will be “fully recovered” in 4 to 6 weeks
. Pain: the pain is manageable – it’s same as any laparoscopic surgery
. Diet & Activity: you will slowly transition back to normal
Diet
Gastric sleeve
Following are dietary guidelines for gastric sleeve:
. Test one food at a time to make sure you can tolerate it
. Eat proteins first, in solid form (e.g., not protein shakes)
. Eat healthy “whole” foods
. Avoid processed foods
. Avoid sugary foods or drinks
. Eat slowly and chew thoroughly
. No starchy foods like rice, bread, and pasta
. Avoid any food that is difficult to digest (may be able to tolerate over time), such as:
. Fibrous vegetables like broccoli, celery, and corn
. Nuts
. Seeds
. Skin of any meat
. Tough meats
. Avoid whole milk products
. Drink 64+ oz (2+ liters) of fluids spread throughout the day
. No drinking 30 minutes before or after meals (other than gastric balloon)
. Alcohol only in moderation
Patient must eat three meals a day containing 600-800 calories per day (recommended for the first 24 months) and about 1000-1200 after that.
Lap Band
. You will be on a restricted diet with vitamin & mineral supplementation once you have a LAP-BAND.
. For the first few days, diet is restricted to water and fluids, such as thin soups.
. Until the end of 4 weeks, liquids and blended foods, such as yogurt and puréed vegetables can be eaten.
. From 4 to 6 weeks, soft foods are introduced.
. After 6 weeks, the person can resume a normal diet.
Comparing cost
Gastric sleeve
The cost of Gastric Sleeve in Iran is between $ 2700 – 3300.
Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.
Lap Band
The cost of Lap Band in Iran is between $ 2700-2900.
Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.