Lap Banding: Adjustable Gastric Banding

Gastric banding uses a band made of a special, plastic like material to make a small pouch and to narrow the passage into the stomach. The band is placed by minimally invasive surgery around the upper stomach, and can be adjusted periodically without additional surgery through a surgically implanted port. Two companies, Allergan and Johnson & Johnson, manufacture FDA approved bands, and it is estimated that within a few years half of all weight-loss surgery will be band placement. There is still some question as to whether Lap-Bands permit long term weight loss comparable to gastric bypass, and whether they are as helpful as gastric bypass in controlling or eliminating diabetes.

Vomiting is a common side effect of this procedure, but recent studies have shown that more serious complications, such as erosion and slippage, can occur. In addition, patients have reported difficulty swallowing, gastroesophageal reflux(GERD), and pain. As many as 5% of Lap Band patients require additional surgery within nine months after band placement, and often hospital stays of up to one week are necessary. Men may be especially prone to Lap Band complications- up to 20% of men had the band removed in the first year. The issue of Lap Band complications is becoming more important because the FDA is now considering loosening the established criteria for Lap Band placement. Some question whether there is enough good information out there to allow implantation in thousands of more patients. Will we save money in the long run by loosening standards, or will we see more and more complications develop? Is more research needed across racial and ethnic lines? Why do men seem to do badly as compared to women? Should Medicare pay millions of dollars more for a procedure whose benefit is uncertain?

Roux-En-Y Gastric Bypass

This procedure utilizes staples to close the stomach and create a small pouch. The small bowel is then directly connected to the pouch and a gastrojejunostomy is created. The surgeon may choose to create a "long-limb" and this procedure is then called a Long-Limbed Roux-en-Y. The rearrangement of the normal anatomy allows food to bypass portions of the small bowel, thus limiting the body's ability to digest food, and allowing undigested food to pass out of the body. Several studies have indicated that weight loss is most effective with Roux-en-Y as compared to gastroplasty or other forms of gastric bypass.

Laparoscopic Gastric Bypass

Laparoscopic procedures are by their very nature minimally invasive. The theory behind minimally invasive surgery is to decrease hospital stays and limit postoperative pain, infections, and problems with wound healing. Since 1993, laparoscopic Roux-en-Y gastric bypass and gastric banding has become increasingly popular. It is estimated that in 2003, almost 60% of bariatric surgery will be done by laparoscopic technique. You must be aware that there continues to be a learning curve for surgeons performing this type of specialized surgery; less experience or inadequate training means more complications, including potentially lethal leaks. Some state medical boards are so concerned by this problem that they have opened investigations. It is vital that you make sure that the surgeon is very experienced not only in laparoscopic surgery in general, but in laparoscopic bariatric surgery in particular.