University of California, San Diego Medical Center – Center for the Treatment of Obesity

LAP-BAND® System

Gastric Bypass

Description: A restrictive procedure, in which an inflatable band is placed around the upper part of the stomach, creating a smaller stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result, a patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion.

Description: A combination procedure that uses both restrictive and malabsorptive elements. First the stomach is stapled to make a smaller pouch. Then most of the stomach and part of the intestines are bypassed by attaching (usually stapling) a part of the intestine to the small stomach pouch. As a result, a patient cannot eat as much and absorbs fewer nutrients and calories.

Advantages:

• Lowest mortality rate
• Least invasive surgical approach
• No stomach stapling or cutting, or intestinal re-routing
• Adjustable
• Reversible
• Lowest operative complication rate
• Low malnutrition risk

Advantages:

• Rapid initial weight loss
• Minimally invasive approach is common
• Longer clinical experience in the U.S.
• Slightly higher total average weight loss reported than with purely restrictive procedures  

Disadvantages:

• Slower initial weight loss
• Regular follow-up critical for optimal results
• Requires an implanted medical device
• In some cases, effectiveness can be reduced due to band slippage
• In some cases, the access port may leak and require minor revisional surgery

Disadvantages:

• Cutting and stapling of stomach and bowel are required
• More operative complications
• Portion of digestive tract is bypassed, reducing absorption of essential nutrients
• Medical complications due to nutritional deficiencies
• "Dumping syndrome" can occur
• Non-adjustable
• Extremely difficult to reverse
• Higher mortality rate

Results: Although during the first year after surgery, weight loss with the gastric bypass is greater than with the LAP-BAND® System, surgeons report that at 5 years many LAP-BAND® and gastric bypass patients achieve comparable weight loss (55% for LAP-BAND® and 59% for Gastric Bypass).

Risks
Mortality rate: 0.05%
Total complications: 9%
Major complications: 0.2%
Most common include:

• Standard risks associated with major surgery
• Nausea and vomiting
• Band slippage (minor revisional surgery)
• Band erosion (minor revisional surgery)
• Access port problems (minor revisional surgery)

Risks
Mortality rate: 0.5-2%
Total complications: 23%
Major complications: 2.1%
Most common include:

• Standard risks associated with major surgery
• Nausea and vomiting
• Separation of stapled areas (major revisional surgery)
• Leaks from staple lines (major revisional surgery)
• Nutritional deficiencies
  

Cost & Insurance
Generally speaking, both procedures will be covered by insurance, but check with your employer or your surgeons office for specific information about your policy. Costs of LAP-BAND® surgery and Gastric Bypass surgery will vary depending upon the site where the surgery occurs (in-patient or out-patient), the type of bypass procedure (laparoscopic or open) and how long you are required to stay in the hospital. One survey of cash prices for both procedures showed the average charge for a LAP-BAND® procedure of $17,500 while the average charge for a laparoscopic gastric bypass was $22,500. The survey did not find any program that offered a cash price for open gastric bypass.

Recovery Timeline

• Hospital stay: Most patients will go home the same day of surgery
• Most patients return to normal activity within 1 week
• Full surgical recovery usually occurs within about 2 weeks

Recovery Timeline

• Hospital stay is usually 48-72 hours
• Many patients return to normal activity within 2.5 weeks
• Full surgical recovery usually occurs within about 3 weeks.