Lapband vs. Gastric Bypass

Sorry, but as a Band practioner, I try to stay very current with the studies and stats. I'm afraid the ones you quote are very old. Here are current ones that show the medium and longterm loss for the Band and the Bypass are equal. Bypass loss is nowhere near the 80% you quoted. I starred the important parts of this current study. We each must make the right decision for ourselves, but having correct info to do so is important. The best to all of you! Sandy R J Obesity surgery, 2006 Systematic review of medium-term weight loss after bariatric operations. O'Brien PE, McPhail T, Chaston TB, Dixon JB. The Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia. [email protected] BACKGROUND: Although bariatric surgery is known to be effective in the short term, the durability of that effect has not been convincingly demonstrated over the medium term (> 3 years) and the long term (> 10 years). The authors studied the durability of weight loss after bariatric surgery based on a systematic review of the published literature. METHODS: All reports published up to September, 2005 were included if they were full papers in refereed journals published in English, of outcomes after Roux-en-Y gastric bypass (RYGBP), and its hybrid procedures of banded bypass (Banded RYGBP) and longlimb bypass (LL-RYGBP), biliopancreatic diversion with or without duodenal switch (BPD+/-DS) or laparoscopic adjustable gastric banding (LAGB). All reports that had at least 100 patients at commencement, and provided > or = 3 years of follow-up data were included. RESULTS: From a total of 1,703 reports extracted, 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD). Pooled data from all the bariatric operations showed effective and durable weight loss to 10 years. *** Mean %EWL for standard RYGBP was higher than for LAGB at years 1 and 2 (67 vs 42; 67 vs 53) but not different at 3, 4, 5, 6 or 7 years (62 vs 55; 58 vs 55; 58 vs 55; 53 vs 50; and 55 vs 51). ***There was 59 %EWL for LAGB at 8 years, and 52 %EWL for RYGBP at 10 years. Both the BPD+/-DS and the Banded RYGBP appeared to show better weight loss than standard RYGBP and LAGB, but with statistically significant differences present at year 5 alone. The LL-RYGBP was not associated with improved %EWL. Important limitations include lack of data on loss to follow-up, failure to identify numbers of patients measured at each data point and lack of data beyond 10 years. ***CONCLUSIONS: All current bariatric operations lead to major weight loss in the medium term. RYGBP ( RNY) and LAGB (BAND) are equal in the medium term and long term weight loss. and here is what Dr TRace Curry , who does both bands and bypasses, says on our Band forum: Post Date: 3/7/07 4:55 am Not only is it possible, it's normal for the RNY pouch to enlarge. All RNY pouches enlarge with time, ask any bypass patient how much they can eat 8 weeks after surgery as opposed to 2 years. This is also why most RNY'ers regain 10-20 lbs after a few years from their lowpoint. Most do not enlarge to the point of regaining all their weight though, probably only 10-15%. This is about the same failure rate as for banding, except band patients who fail usually don't lose a lot of weight first then regain, they just don't lose it to begin with. This is why I think some surgeons feel the bypass has a lower failure rate because of the FALSE sense of succes during the first year or so with these 10-15%. Dr. Curry Cincinnati, Ohio Got a question? Ask the doctor at www.TheBandDoctor.com 877.442.BAND

Your "New" study is made up of a mixture of old studies...it does not say how far back its studies go or how much data they had on each procedure. Your study had nothing to do with a permenent stay in the body which was the point you were making but have yet to back up especially since the manufactuer states they don't know yet and anticipate the lap band needing to be replaced. Your study also doesn't have enough data on lap bands after year 10. I wonder why? Oh because people have to have their lap band removed after year 10 due to the complication of your body rejecting it. How many in your precious lap band forum or support groups have had their lap bands longer than 10 years? Your own manufactuerer stated that ALMOST HALF of patients within 3 YEARS had their lap band REMOVED due to complications! 88% of ALL PATIENTS had one or more SERIOUS complications. RNY pouch enlargement. Wow, talk about exaggerating the facts and reconstructing them to your own end! The pouch is DESIGNED to stretch. At first it is designed to hold 2 oz and stretch to 1/2 cups around the 6 month to 1 year mark. At that time most people have lost TOO MUCH WEIGHT and actually regain that 10-15% back that they don't mind gaining back. It is not a failure, it is a preplanned event. As far as a you being a "band practioner" first and foremost you should be unbiased which clearly you are not. You should have linked your study not just put down the parts that make your point. Any quote coming from "thebanddoctor.com" is not going to be an unbiased view. I have never and will never say that the lap band is a procedure not worth doing. I think the results CAN be the same as RNY. I think there is enough half information on the internet from unprofessionals to back up any stance you want to make on any weight loss topic...that doesn't make it correct. There are NO definitive textbooks or globally peer reviewed studies that have withstood the test of time to definitively indicate anything at this time regarding ANY weight loss procedure. I think that is what makes everything so difficult for us. There is NO standard procedure for this or that set of cir****tances. There is NO standard nutritional program for each procedure. For every nutritionist there is a different program. There are a few common threads of thought (multi-vitamins, concentrate on protein, etc.) but there are a wide variety of paths for each topic. The reason I chose RNY is because it is extreme and it is PERMANENT. A few years down the road I can't decide to make an appointment to uninflate my lap band because I want to go on a cruise. I can't decide that I've got it on my own and take it out and risk regaining. Both procedures have risks associated. Both procedures can risk re-gaining it's what you do with them that determine your outcome. RNY does give you issues with food....BUT ITS FOOD YOU SHOULDN"T BE EATING ANYWAY. It's the food that got us into this situation of being qualified to have weight loss sugery. It's sugar and things containing sugar or have little to no nutritional value (bread, pasta, treats, etc.). Those that give advice should learn to take it. Good luck to everyone having weight loss sugery and I am positive that your stories will be sucsess stories. ~Christal/dionysus_star

Wow! I am surprised by the resentment and defensiveness received by the statements of facts. I think that the lap band is a personal and medical choice that is right for some people. However, deluding yourself into not accepting the facts and risks of a surgery is appalling. I recommend everyone considering lap band surgery that think their lap band will be life long re-read the manufactuer's website under product information. The manufactuer's website specifically states that: "It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure." "The band can erode into the stomach. This can happen right after surgery or years later." The manufactuer's website does not have ANY reports of longer than 3 years. Within the small time frame of 3 years 44.3% of Lap Band patients required second surgery, 25% of which had the lap band removed. Lap Band Manufacturer Website: http://www.allerganandinamed.com/products/obesity/us/patient/lapband/risk.html ================================= "United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events. Lap-Band removed within 3 years of procedure (25%) Second surgery was needed to fix a problem with the band or initial surgery (9%)* *band was removed Additional procedure to fix a leaking or twisted access port (9%) Band erode into the stomach (4 out of 299 1.3%)* band was removed (25%+9%+9%+1.3%= 44.3%) Nausea and vomiting (51%) Regurgitation (34%) Band slippage/Pouch dilatation (24%) Stomach-band outlet blockage (14%) Poor esophageal function (11%) Constipation, diarrhea and difficulty swallowing (9%) Is there a chance the device will need to be removed? The LAP-BAND System is a long-term implant, but it may have to be removed or replaced at any time. For instance, the device may need to be removed to manage any adverse reactions you might have. ********Long term is 10 years....not life long. There are also problems that can occur that are directly related to the LAP-BAND System: -The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them. -The band can slip. -There can be stomach slippage. -The stomach pouch can enlarge. -The stoma (stomach outlet) can be blocked. -The band can erode into the stomach. Obstruction of the stoma can be caused by: -food -swelling -improper placement of the band -the band being over-inflated -band or stomach slippage -stomach pouch twisting -stomach pouch enlargement

Sounds to me like Inamed trying to cover there A$$ legally.. I would venture to guess the legal who-ha for the bypass would be as long or longer.

I agree its to cover their butts legally...but I think it's them trying to present their product in the most favorable light and not just coming out and saying the truth in plain language. The product and operation are still new in the medical viewpoint and they are still trying to figure out how long it lasts on average. I will try and find the reports from an unbiased party. My only issue is that some people think that the lap band is forever and as more time passes people are having issues. The lap band isn't forever...that doesn't mean it's not worth it. I just thought when someone asks for information that that is a good point to make. A previous poster stated that she never saw a study where someone had the lap band absorbed into the stomach. Well 4 out of 299 had it happen within 3 years. If I was one of the 4 it would be important to me. Over 30% of people had their bands taken out within 3 years...thats huge and thats from the horses mouth. ~Christal/dionysus_star

New Surgery Tech create new studies!!! Lapband can be for life if you so choose. The important point here is IF YOU SO CHOOSE. Bypass there is no choice its for life!!! I like my choices!!! I don't have a band so don't link me with those die hard banders. I have done alot of research and I am a RN and I have talked with several surgeons. Sandy is correct on here statistics. These are new numbers. Good Luck

You are pre-op or new at least. You are dealing with head knowledge. That knowledge is important, but not all inclusive. I will be watching your progress on your blog. I want to see how you handle YOUR choice.

my comment was directed at ~Christal/dionysus_star

Anne, I a bander. Here's another take on the band vs bypass "A new analysis of bariatric surgery patients, published in the journal Nature, reveals that this surgical procedure may be far more dangerous than most people believe. An astonishing 4.6 percent of patients who undergo bariatric surgery are dead within a year. That's almost one out of 20 people who die within a year following the surgery. That's a huge number, and it indicates the level of risk associated with bariatric surgery. With the number of bariatric surgeries performed each year in this country approaching 50,000, we're talking about several thousand people dying each year from this procedure". Or "As with any other medical procedure, you must consider the pro and cons of lap band surgery before making your decision. About one in 300 people die from lap band surgery. This is a less than one percent risk, but it is still an important consideration. Only you can decide if the potential rewards outweigh the risks of surgery". There is a large amount of information about these surgeries on the internet. Just do your research and then decide which is the best for you. Also look at issues such as dumping which you don't get with lap band and malabsorption issues which you don't have with lap band. And for some straight information about both procedures, here is the link to the American Society For Bariatric Surgery http://www.asbs.org/html/patients/toc.html They have gross pictures and everything! That should answer your questions including the mortality ones I brought up. Kathleen

I think I would consider the source. Not the magazines and reports (ALTHOUGH THAT TOO) but who is typing this stuff to you. If you are pre-op, on any surgery, it is harder to get a big picture of the ups and downs of any surgery. You go in with the education you can, and you pick what is right for your life, your beliefs, your style of eating, your size, your body response to pain, your love/hate of hospitals, your friends/family response, your finances and insurance issues....and you choose. Then you get operated on and live with your choice. Some people choose to engage in their choice, instead of fighting with it, some people drop pounds like hot lava others it melts off. Some have complications, some don't These rny VS Band Or any "VS" discussions serve only one purpose. Its gets people riled up to find the stats to support the choice they are either leaning to or already made. Which is good. This board is about info. I got most of my info (except for the hard med stats) from the profiles here. How did people deal with the choices they made. How would I? What were the practical problems/joys to the choice they made. I have more than earned the right to comment on the band. Check out my blog. I love my band still. No matter what it is a part of me, a choice I made Aug 10 06, and adopted "child" in my body that will not be removed, that has changed my life for the good over all, even when it acts up. I would consider the profiles of the people who type suggestions, facts and if pre-op, head knowledge-only ideas here. Then trust and accept and work with your choice.