Lapband or Gastric Bypass???

Hi, I have my surgery Bypass scheduled for June 3 and I am getting cold feet.  I am trying to figure out why I would go for the bypass over the band or vice versa?  Anyone have any advice?? 

I was originally interested in the band. However, as I studied the options, I realized that I needed something "stonger" than the band. I knew I could eat my way around the band. With the RNY, I have the deterrant of dumping syndrome if I consume too much sugar and/or fat. Sweets and bad carbs were my major weakness, so I knew that dumping syndrome would be beneficial to me. And it really has been. I can enjoy "a little" of the things I loved, and it is truly enough. I enjoy it and it's over. Not the beginning of the chain-reaction it used to be for me. Before if I had some, I just wanted more.

Also, consider how much weight you need to lose. I was hoping to lose around 125 lbs. (which I was able to do). If you are a lightweight, maybe the band will be enough. If you have quite a large amount to lose, you will probably do better with the RNY.

Be honest with yourself about what your triggers are, investigate the surgeries and make your decision.
Good luck to you --
Maria

Hi Maria,

I want to thank you for your reply.   What you said hits home since I too am afraid with the band that I could eat around it.  I have heard that from many people.  I think im just gettting cold feet. 

Thanks so much
Carrie

This is the long and short of it...RESEARCH RESEARCH RESEARCH! All surgeries have risks, all have benefits which one will be best fit for you and what risks are you willing to take and what potential outcomes are you looking for makes your decision personal!

Have you explored tht sleeve and the BPD/DS????
Leave no stone unturned!!!

Know that all surgeries have risks and benefits. Making an informed and educted decision is recommended for each of us individually.

We all have biases, we all have opinions and we are all right for ourselves; judging choices of others is not helpful. Sharing our experiences, strength and hope can be helpful IMHO. You will hear success with any surgry and you will hear failure as well. You will hear about revisions from any tool. NONE are magic or perfect!

I am pro WLS, whatever that means to an individual. I am glad we have choices! I originally researched the lapband after that I decided for me I wanted lap Gastric Bypass. Happy with my choice 6++ yrs out....I can say I now beleive that BPD/DS would be my choice based on what I now know; but in 2002 I didnt have that choice with insurance or local surgeons.

You can spin statistics anyway you want...I can share reasons that the lap band seems great or why it seems a horrible choice...I can do the same for any surgery....GBP, Sleeve, DS, MGBP etc......

For instance one article stated Lapband and RNY at 5 yrs had both 50% excess wt loss, sure because that study did not include lapband failures, remembering that 30% of those with bands get them removed (complications, failure etc) when that is factored in RNY at 3 yr was 73% excess wt loss and bands were 37% big difference (different spin see!)...want articles I have them just email me off list [email protected]

Longer one has a band higher complication rates go, so early on seem low vs bypass later on exceeds greatly!

BPD/DS I feel is the surgery of choice for super morbidly obese, it has record of greatest excess wt loss over time...I agree a person with BMI over 50 the stats I have seen show that (band or proximal bypass) are not enough to impact comorbidities, 30-50% excess wt loss when one is 200# or more overwt is not worth risk, the Sleeve as step one and then BPD/DS as step 2 seems the way to go for many..Lap Bypass seems to not get Super Morbidly obese (BMI > 50) close to normal BMI either....it is not meant to.....

Sleeve and band may give same excess wt loss but sleeve changes internal hormonal mileu having greater impact it seems on metabolic issues like diabetes, appetite suppression. Bands are contraindicated with autoimmune disease like Lupus, Gastric sleeve is of choice fo those with Chrones disease over other malabsorbtive surgeries.....


What is surgeon recommending how high is your BMI, what is your age, comorbidities, what are your eating issues (sweet eater?) these all factor into a decision for you...talk to successful and failed bypassers, talk to successful and failed banders, talk to same BPD/DSers or sleeve folks. Obesity Help foorums are great for gaining insight. What risks are you willing to accept what is the amoutn of wt you want to lose? Those help guide surgical choice....Nothing is magic they all require lifestime dedication to a change in lifestyle meaning healthy food choices, emotional regulation and exercise as well as followup with bariatric professionals for labs etc! This is DAMN hard work!
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Be educated be informed, remember all sites, articles and personal replies (mine included) come with disclaimer of some bias! You'd NEVER convince me to get a band EVER I have seen too many issues with close friends and those in my support groups I facilitate (erosions, slips, perforating stomach, port flips, infected ports, disconnected tubing... faiures on failures, defeating the tool getting revision to bypass more and more) but that is me...You probably wouldn't convinve me to get a proximal lap bypass again either due to the issues of stretched stomas, wt regain etc....but hindsight is 20/20! The BPD/DS is not perfect it is for the HIGLY motivated and compliant person due to nutritional issues for life that are needed to be monitored (not that RNY isnt either but seems distal bypass or DS more so).... Again my choices may differ greatly form others!

LOOK AT ALL YOUR CHOICES (what insurance will pay and what the surgeons around you do!)


Here is another email I save and send some info may be same but there is differnt info here too!


Deciding to have WLS is a major, life-changing event and shouldn't be made on impulse (I am not saying this is you I am saying this for anyone thinking about it!). I recommend anyone be 110% sure this is what you want to do because it is PERMANENT! Things to think about: · How long have you been researching WLS?**Hopefully at least a good 6 months or so****for many it is years! · Do you understand the procedure, I mean really understand the nitty gritty of what they are going to do to your intestinal system! Not just it will help me lose weight but *for instance w/ the Roux-En-Y gastric bypass* that they are going to cut your stomach in 2,make a small pouch, the old stomach hopefully is transected from pouch by staples and surgically cut in 2! Then the intestines are cut a few feet or so down and rerouted so you lose weight because the tummy is restrictive and bypassing the intestines decreases absorption....Know the risks involved with this!!!***(Nutritional/metabolic/physical/psychosocial): ex B12 and vitamin deficiencies/protein deficiency/hernia/adhesions, risk of depression post op related to grief over loss of food and hormonal surge of estrogen/trauma of surgery, marital/relational difficulties/high divorce rate)... · Surgical risks: (not all inclusive.. ~Bleeding, ~Complications due to anesthesia and medications, ~Deep vein thrombosis/clots, ~Wound Dehiscence, ~Infections, ~Pulmonary problems, ~Spleen/Liver injury, ~Stenosis of new connections (stricture), ~Hernia, ~Death. · Depression possibly related to grieving the loss of food, decreased metabolism, and hormonal surges from estrogen being released into the body from rapid wt loss/fat breakdown.... · Gallstones....need for 2nd surgery to remove this. · Long-term osteoporosis (metabolic bone disease), severe vitamin./mineral deficiencies · Hair loss (temporary due to anesthesia, trauma of surgery but will continue if you are protien/vit and mineral deficient!) · Food intolerances (possibly meats, esp. red meat, lactose intolerance, sugar, fats, fried food) · Dumping syndrome
(Nausea/vomiting/diarrhea/chestpain/palatations/sweating/tiredness for minutes/hours/days) *when eating highly concentrated fats or sugars (a desired behavioral response that ~ 50% of post-ops get) · EXCESS SKIN....OK my philosophy is you fit in your skin or you don't...Do say you don't want to feel bad after, ask yourself do you feel bad now? If yes are you healthy now as a MO person? Yeah many insurance companies pay for some plastic surgeries if medically necessary it may be a fight, but you can get some of it removed possibly....If though this will deter you I say the chances are great you will have some amount of excess skin, no one knows how much...Age, gender, prior diet/weight changes, pregnancies all affect this and the best chance on has to control this is (although limited) exercise, water and protein....So if this is a huge issue don't have surgery.......Excess skin may be by far the most distressing side-effect for people as we already come with altered self-esteem/body image!!! · What type of research have you done? (Internet, in-person support group meetings, talking with others who have had surgery, surgeon consult, surgeon seminar, articles, books?????)***Knowledge is power and is the best tool we have for success and happiness afterwards**** · What are your present support systems? Friends, Family, co-workers.....**Although not 100% necessary if others are on board it sure as heck makes the ride all that much easier!!!*** · What are your current stressors? ***WLS is a time when you need to be as stable as possible, going through a divorce, bankruptcy, death of a close relative, job loss...well WLS may be a good option but pick the optimal time as it is stressful enough if everything is good, when you are going through something extra stressful you are hampering your success possibly and not having the old standby of food to rely on can be HELL!***This is not to say there ever is a right time and things can happen post-op but be kind to yourself and do what's best for you, waiting 3 months may make all the difference in the world! After all this is about forever!!! · What is your nutritional/obesity/diet history?***WLS is not for everyone, it is for the Morbidly obese (BMI above 40 or 35 with major comorbdities such as sleep apnea, Coronary disease, Diabetes....)This should be no ones first attempt at dieting (*I know this is not yours again just general guidelines)...Anyone who says this is the easy way out, KNOWS NOTHING about the surgery or the struggles you will endure and lifestyle changes necessary post-op for success! They are usually ignorant, jealous or both! Again your education and knowledge here goes a long way...Everyone seems to know someone who 'died' or had a 'terrible experience' with WLS...BUT no one seems to have a name or number to call that person!!! It is again based on hearsay a lot of the time and their own fears and insecurities...You are doing this for you remember that, it is nice to have support, so educate friends and family, bring them to a support group!!! It can only help! Many programs require wt loss preop...I know many people disagree with this or don't understand why..IMHO I think it is a generally good idea to start instilling dietary, exercise and overall lifestyle changes preop, there is nothing magical about the surgery that makes u wake up and think like a thin person (*I WISH!!!!) So making small changes are helpful pre-op...EXERCISE is one of the biggest keys to success (IMHO again) and anything you can do preop will help you keep up with this and be healthier for surgery!! (and a better surgical risk!)...Start eating smaller portions, it is hard if you go from eating super sized fast food today to clear liquids for 2 weeks (*this is my equivalent of psychological hell/torture!!!) Start slowing down when you eat, put that fork down in-between bites, cut up your food to small pieces, stop drinking and eating at the same time (cant do it or shouldn't postop so start now!) Start taking in 64 ounces of fluid a day if u aren't already, will need to postop! Cut out carbonation, caffeine, sugar, alcohol and chocolate (these are 5 recommended things to avoid postop for many esp. in the first year) again make postop life easier on yourself not harder start ahead!!!!Try on new coping skills for size, they wont miraculously appear postop! Stock the house with clear liquids, crystal lite, diet kool-aid, broth, diet jello etc so u are ready when u get home!!!!Try and avoid the 'last supper syndrome' you will eat most everything again eventually, perhaps in smaller quantities, so don't have a feast each night of things u think u will never have again! · Ask yourself: What is my ability to make lifestyle changes? Be compliant with post-op recommendations??? This is only a tool....(*sorry can't say that enough!).... a. Need to exercise nearly daily for health/wt loss and help with excess skin b. Need to supplement with B12, multivitamin, folate, Iron, Zinc, Calcium citrate, protein shakes possibly give or take things. c. Need for LIFELONG FOLLOW UP!!!! If you're not taking care of self now you MUST postop or you may trade far worse illnesses for the Morbid obesity you have now malnutrition and vit/mineral def can be permanent and irreversible! · Know that extended release medications may not be as effective or absorbed well (**esp. birth control pills in woman of childbearing age use alternative form of BC) I could probably ramble on all day about this..I hope some of this helps you! Any specific ? email us or me offline! Take care and good luck it is an awesome journey!! *not perfect and a positive attitude helps! DO this for you and only you!!!!Start journaling now www.obesityhelp.com is a great site, start your own profile there! Also if you haven't seen this document
(pouch rules) print and read! A good basic guide to things that will help you use the tool and be successful as possible (*for most of us!!!) http://www.digitalhorsewoman.com/pouchrules.htm



The Bypass as well as the lapband have all of the risks that come with having an operation, the lapband may involve shorter OR time and no rerouting of intestines. Both can lead to gallstones & excess skin r/t wt loss, Neither is "SAFE" BOTH need to be considered carefully and not taken lightly...it must be an informed decision and used only as a last resort for people who are 100lbs overweight or have a BMI of 40 or greater, unless their BMI is 35 and they have comorbidities (DM, HTN, sleep apnea...) The surgeon really should be going over all the risk/benefits with the patient, whichever procedure they the PERSON chooses. I would though encourage anyone who is contemplating this to educate him or her to make the best-informed decision possible. Weight loss surgery is not for everyone. I am glad there are different options, because not everyone can have a bypass...and the band is an option for those that cannot/do not (want to) have their GI system altered. I promote weightloss surgery (band or gastric bypass) to those that are informed and understand the risks/benefits and have weighed them heavily!. The bypass is what I know most about and have had. WHY? There is more research on this surgery (IN THE US), it has been around longer, perfected, esp. in regards to weight loss (depending what research you look at the band may only give the person a 38% wt. loss vs. 78% wt loss is a standard for GBP), The band has only been used in this country since June/July 2001 (In Europe 10-15 years). and long-term complications still are not all known, Can the band stay in forever? Who knows, many do opt to get a bypass after ineffective wt. loss with the band, (So why go thru 2 operations if the bypass will be your final destination? IF your insurance will pay for a SECOND operation?!), many see the band the same in terms of wt. loss as the VGB (vertical gastric band, which has almost been abandoned or revised to bypasses in this country r/t ineffective wt loss (no malabsorption). With the band, there are risks such as: stomach perforation, pouch enlargement r/t band placement/slippage, band slippage, erosion of the band, erosion of band into the stomach, body rejects foreign object (the band), access port problems (flipping etc), saline evaporating from port requiring more f/up fills, more follow-up is needed for the fills.....Also the lapband is not done everywhere yet in this country, insurance companies are still reluctant to pay for it, insurance companies are paying for the bypass, without much issue. These are the reasons I chose what I chose...

I am not implying Bypass is not without risks, It has many risks...more serious? Depends which side-effect/complication you get, depends who you talk to....I had a complication, but came through it fine, I had adhesions and scarring that caused a stricture on my small bowel, this could of happened if I had the lap band, our bodies make adhesions, it is a risk of abdominal surgery...mine were in the wrong place and caused a problem! Malabsorption...which in essence means lifelong follow-up with a clinical nutritionist, for labs... and supplements of: calcium, iron (maybe), B12, folate
(maybe) and a multivitamin for life. Protein also needs to be a focus of the bypass persons diet, and sometimes supplementation is needed. Hair thinning at 3 months, r/t protein deficiency, but it grows back in full after a few months
(not baldness mind you thinning) Dumping syndrome...now some say this is a benefit, sort of the ultimate behavior modification..if you eat sugar/fat you feel awful, tired, nausea, diarrhea..so you don't eat that food again!

What is agreed on is careful screening medically, surgically, nutritionally as well as emotionally/psychologically. Eating disorders need to be looked at, esp. compulsive eating. A good aftercare plan is key, having a multidisciplinary team to follow you (Good PCP, Surgeon, Nutritionist, therapist, support group) are all factors shown in research to lead a person to the best outcome/wt. loss possible.

THERE REALLY IS NO WAY TO OUTLINE EVERYTHING THAT IS GOOD/BAD/UGLY WITH EITHER PROCEDURE. FOR ME BYPASS WAS THE ANSWER, FOR SOMEONE ELSE IT MAY BE THE BAND. GOOD LUCK! How To Choose A Bariatric Surgeon http://www.beyondchange-obesity.com/medicalMatters/howToChooseASurgeon.html

When you're looking for a Bariatric surgeon/points to ponder: http://www.amylhwilliams.com/questionsforsurgeon.html good link also

1) Check out info on this site: http://www.nydoctorprofile.com/ (*search under his name & look for any malpractice suits, payouts etc. You can ask about that).

2) Is he board-certified by the American Board of Surgery? www.absurgery.org American College of Surgeons? http://web3.facs.org/acsdir/public/Detail.cfm?CHKDGTS=00299031800

3) Is he a member of the American Society of Bariatric Surgeons? http://www.asbs.org/html/about/membersearch2.html

4) What is the mortality rate (is the number of deaths) of the surgeon, the success rate (those losing > 50% of their excess wt at 5 yrs out)? Complication rates (wound infections, hernias, strictures, leaks, reoperation etc)? Average length of time in hospital.

5) The surgeon you find should be well experienced in the area of weight loss surgery (BARIATRICS). It's clear that the more experienced the surgeon, the lower the risk of mortality. Ideally, you would prefer to find a surgeon who has performed at least 100 of these procedures. (I say over 500!). I also recommend a surgeon who dedictes his practice to WLS, not one who does a case a week....

6) What you are looking for doesn't stop with numbers and statistics -- you will also need a multidisciplinary team one that includes: Surgeon, nutritionist, exercise physiologists, psychological support & support groups, that can be utilized pre- and post-operatively.

7) Look for a center or hospital that offers educational seminars to those who are just beginning the process so you can learn more about the actual procedure, the benefits, and the risks.

8) Is the hospital a Bariatric Center of Excellence? http://www.asbs.org/html/about/coe.html or http://www.surgicalreview.org/locate.aspx http://www.facs.org/viewing/cqi/bscn/fullapproval.html

9) The preparation, both physical and mental, comes next, and is as crucial to the entire process as the actual procedure. Look to a surgeon that requires clearance from (what is indicated w/ your particular medical status) various doctors (psych/endocrine/hemotology/pulmonary/cardiology/nutrition etc). No this is not @ hoops this is making sure your health status is optimized before surgery. Preop smoking cessation, preop wt loss..etc.

10) What procedures does he do? Open or Lap? What is his follow up plan? Recovery time?

Education is a tremendously important part of the preoperative process & there is no question that there are major risks associated with the operation. However, those risks can be minimized by having a thorough preoperative workup so there aren't surprises during the procedure, and by making sure the surgeon is experienced and qualified. This is a courageous step for people to take, and it's not just about weight changing -- it's about life changing. SO take your time, find the right surgeon/surgical program for you for your life and your health and success long-term! WLS is a decision many of us make, but should not be made impulsively (*the average time one thinks about and has WLS is 2 yrs!) as we as MO people can feel quite desperate and see this as a last resort and can sometimes go with whoever is telling us they will perform, that may not be in our best interest! EDUCATION IS KEY, AS IS A COMMITMENT & dedication to a healthy diet and exercise regimen, continual follow-up with doctors to monitor progress, and commitment to a new life.

Ask him all these questions or any others think of or you think of, if HE isn't right, find someone who is! After all you're putting your life in his hands and needing someone to care for you for life!!! Be an educated consumer of your own health! HUGS!


Take Care

Laparoscopic RNY Gastric Bypass vs LAP-BAND
Laparoscopic RNY Gastric Bypass still comprises over 80% of all weight loss operations in the United States for good reasons, and is predominant in the best medical centers. LAP-BAND, on the other hand, was given to only the most respected bariatric surgeons in this country by the FDA to trial around 2000. Despite receiving FDA approval in 2001 it has been rejected almost universally by those American experts in favor of gastric bypass because of unacceptable long term results. Furthermore, surgeons in Europe who have "banded" for over a decade (almost universally) are starting to do gastric bypass preferentially, or as "rescue or revision" operations on their failed LAP-BAND patients. Nevertheless, LAP-BAND is an easy operation to perform, with few early complications associated with the operation itself. As such, it is very popular with surgeons starting to do bariatric surgery, and has led to alarmist and sometimes absurd references to outdated and antiquated data about gastric bypass in order for those surgeons to promote the LAP-BAND. No mention is made by those surgeons of the poor weight loss results, and the more alarming long-term complications associated with LAP-BAND.
An ideal operation should accomplish two goals:
1. Provide optimal weight loss.
2. Allow for normal eating habits and lifestyle indefinitely.

FACTS AND MYTHS
THE OPERATION
FACT:
Laparoscopic RNY Gastric Bypass is a difficult operation to perform safely and may require the experience of 100 operations for a surgeon to attain excellence - but that goal can be accomplished. One simply needs to search for an experienced surgeon performing laparoscopic gastric bypass.
-Schauer, P. et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.
Surgical Endoscopy. Vol. 17, 2003
LAP-BAND is easy to perform and is therefore a "safe" operation.

WEIGHT LOSS
MYTH:
LAP-BAND is "as effective for weight loss as Laparoscopic RNY Gastric Bypass".
FACT:
Six of the best bariatric centers in the country doing Laparoscopic Gastric Bypass have demonstrated "excess body weight loss" (EBWL) of 69 to 84% at one year. We have averaged 82% EBWL at one year in almost 200 patients, and many of our patients reach "ideal body weight".
Most reports of weight loss with LAP-BAND range from 45 to 55% EBWL, with one of the best reports coming from Australia at 57%--that took six years to attain. Many experts believe that almost 50% of LAP-BAND patients have less than 50% EBWL (generally regarded as a surgical failure).
With LAP-BAND "... weight loss was insufficient in slightly over 40% of the patients..."
-Suter, M., et al. Laparoscopic Gastric Banding: A prospective randomized study...
Annals of Surgery, January, 2005.
A comparison of weight loss with bypass and banding, respectively, in 1200 patients showed EBWL "... 74.6% versus 40.4% at 18 months...".
-Gagner, M. Laparoscopic Gastric Bypass versus Laparoscopic Adjustable Gastric Banding: A Comparative Study of 1200 Cases.
Journal of the American College of Surgeons, October, 2003.

RISK OF DEATH FROM OPERATION
MYTH:
LAP-BAND is much safer than Laparoscopic RNY Gastric Bypass.
FACT:
The mortality rate with LAP-BAND is boasted to be about 0.05%. Mortality rate from recent data at six reputable centers doing Laparoscopic Gastric Bypass (including ours) which comprised a total of 2389 patients was 0.08%. This difference is not even statistically significant!

RISK OF COMPLICATIONS FROM SURGERY
MYTH:
LAP-BAND has fewer complications than Laparoscopic Gastric Bypass.
FACT:
The 1200 patient comparative study showed an "early complication rate" (first week after operation) of 4.2% with bypass and 1.7% with banding. "Late complications" (the first 18 months after operation****urred in 8.1% with bypass and 9.1% with banding. Beyond this time, however, bypass patients will have almost none, while the band patients, with the foreign body in place, will see inexorable progression of complications over time.
One "estimate of the failure rate (from complications with bands) indicates that removal is expected in almost one out of ten patients every year".
-Scopinaro, N., et al. Thirteen Years of Follow-up in Patients with Adjustable Silicone Gastric Banding for Obesity: Weight Loss and Constant Rate of Late Specific Complications.
Obesity Surgery, Volume 14, 2004.
In another scientific surgical report there were 44% "late complications in 103 patients...20% had to be converted to gastric bypass...".
-Weber, M., et al. Laparoscopic Gastric Bypass is Superior to Laparoscopic Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery, December, 2004.
"Increasing experience with LAGB (bands) has shown a high incidence of long-term failure and complications...15-58% of the cases. Most of these complications require reexploration."
" As more than 70,000 patients worldwide have received a gastric banding over the past decades, it can be predicted that many patients will require 'rescue' or revision operations."
-Mognol, P. et al. Laparoscopic Conversion of Laparoscopic Gastric Banding to Roux-en-Y Gastric Bypass: A review of 70 patients. Obesity Surgery. Vol. 14, 2004.
"... increasing experience with laparoscopic gastric banding (LAP-BAND) has shown a high incidence of long term failure...it can be predicted that we will see many patients requiring rescue procedures..."
-Clavien, P. et al. Laparoscopic Roux-en-Y Gastric Bypass, but Not Re-banding, Should Be Proposed as Rescue Procedure for Patients with Failed Laparoscopic Gastric Banding.
Annals of Surgery. December, 2003.

REVERSIBILITY
MYTH:
LAP-BAND is reversible. (As though the other operations were not!)
FACT:
If one could conjure up a scenario why a weight loss operation would have to be reversed, laparoscopic gastric bypass could be reversed with a laparoscopic procedure at many institutions with a two day hospitalization and one week recovery.
Why would you tout a treatment for a lifelong disease such as obesity as having the benefit of being temporary, unless you knew it would have to be temporary? Obesity would return rapidly. A good operation should be done "for life", and provide normal eating patterns and normal quality of life. Thousands of patients are now twenty years out from their Roux-en-Y gastric bypass with no problems, whatsoever.

LONG TERM WEIGHT LOSS MAINTENANCE
MYTH:
With RNY you will regain your weight.
FACT:
It has been documented with long term follow-up that weight loss remains excellent over five years after the operation.
-MacLean, L., et al. Late Outcome of Isolated Gastric Bypass.
Annals of Surgery. April, 2000.
http://www.thinidaho.com/index.php?pageebate

Weight Loss Surgery: Restrictive, Malabsorptive, and Combination


In this artticle we'll look at the three types of Weight Loss Surgery: Restrictive, Malabsorptive, and Combination Surgeries
Restrictive Surgeries

Restrictive weight loss surgeries are the least preferred option by the medical community. There are two types of restrictive surgeries.

Adjustable Gastric Banding (AGB) or LapBand®

An elastic band made from a special silicone material is placed around the upper part of the stomach to create a small pouch. The pouch can hold only a small amount of food at one time generally just 1 ounce to begin with which later expands to 2-3 ounces. The opening of the small pouch to the larger pouch or the majority of the stomach is very small -- only about a quarter of an inch. The food thus passes from the small pouch to the large pouch very slowly and one feels full longer with a lesser amount of food.

Pros of LapBand® surgery:
The biggest advantage is that there is no removal of any body part including stomach and intestines.
The body is not altered in any unnatural ways.
Recovery period is short.
A simple procedure that is fairly safe.
Less possibility of complications.
Cons of LapBand® surgery:
A 5% possibility of complications that include an internal infection, erosion/damage to the band or leakage from the small pouch.
Some patients simply cannot eat after the operation, which can cause problems.
Less successful than malabsorptive techniques in maintaining long-term weight loss.

Vertical Banded Gastroplasty (VBG)

This is the most commonly used type of restrictive surgery. It is similar to LapBand® surgery except that VBG uses both bands and staples to create the small stomach pouch.

Pros of VBG surgery:
The biggest advantage, and the reason why it is so preferred, is that the procedure is completely reversible.
The body is not altered in any unnatural ways.
The food passes through the body slowly and steadily so no dumping syndrome.
Recovery period is short.
A simple procedure that is fairly safe.
Less possibility of complications.

Cons of VBG surgery:
Less successful than malabsorptive techniques in maintaining long-term weight loss.
Requires the patient to follow a strict diet plan to avoid any complications.
If the patient eats too quickly or does not chew the food properly it can lead to vomiting.

Malabsorptive & Combination Surgical Procedures

Malabsorptive procedures are generally more successful in long-term weight loss than restrictive procedures. Malabsorptive procedures bypass a portion of the intestine by creating a direct connection from the stomach to the lower portion of the intestine. The food then comes in contact with a smaller portion of the intestine. Thus, fewer calories are absorbed into the body, resulting in weight loss. There are three different types of malabsorptive and combination procedures.

Roux-en-Y Gastric Bypass (RNY)

This is the most common of all bariatric surgeries. A small pouch is created by stapling the upper portion of the stomach to reduce food intake. A Y shaped section of the intestine is then attached to the pouch.
This allows the food to bypass the first two portions of the intestine and severely restricts absorption of calories and nutrients thus effecting weight loss.
In one study it was found that almost 2% of patients who had undergone RNY died within thirty days of having the surgery.
However, 27% fewer patients that had the surgery died
than those who did not in a 15-year follow up.
This suggests that the surgery is definitely helpful but risky as well. (Source: Journal of American College of Surgeons, Oct 2004) Some studies have shown that patients who undergo RGB lose an average of a 100 pounds after surgery.

Pros of RNY surgery:
An average 77% of excessive body weight is lost after one year. Patients have been found to keep off almost 50-60% of the weight loss, even after 10-14 years. This is definitely the most effective long-term weight loss surgery available today.
A reversible procedure, though not easily.
Severely controls the ability to eat food.
Found to provide a cure for other obesity-related problems like sleep apnea, back pain, diabetes, high blood pressure, and even depression.
Cons of RNY surgery:
Possible complications can arise if the staples used to create the small pouch fail to do their job effectively.
Possibility of the patient developing ulcers and hernias.
The narrowing of the stoma (stomach outlet) can cause it to get blocked.
If the patient eats too quickly or does not chew the food properly it can lead to vomiting.
The dumping syndrome can occur due to high intake of sugar, fats, or overeating. The contents of the stomach are literally dumped too quickly into the intestine and can cause nausea, weakness, fainting, diarrhea and sweating.
Can cause nutritional deficiencies over a period of time. Vitamin and mineral supplementation is essential. If the patient fails to take supplements as prescribed by the doctor for life it can cause major deficiencies.
This procedure requires close monitoring of the patient and lifelong restrictive eating habits. Also, regular check ups and follow ups are a must for life.

Biliopancreatic Diversion (BPD) or Scopinaro Procedure

In this type of surgery portions of the stomach are actually removed and just a small pouch is left behind. This pouch is then directly connected to the last portion of the intestine completely bypassing the duodenum and jejunum.

Pros of BPD surgery:
The stomach capacity is 4-5 ounces with BPD so one can lose weight and still enjoy a healthy meal.
There is significant weight loss that is maintained over a long period of time.

Cons of BPD surgery:
Portions of the stomach are removed from the body and altering the natural body can always create problems.
High risk of developing ulcers, chronic diarrhea, and pungent stools and flatulence.
Since the duodenum and jejunum are completely bypassed, the patient invariably suffers from nutritional deficiencies. These must be supplemented carefully.
Calcium and vitamin deficiencies are also possible.
High chance of dumping syndrome.

Duodenal Switch (BPD/DS)

The duodenal switch is similar to BPD but less invasive. It leaves larger portions of the stomach intact and also retains the pyloric valve that controls the release of the stomach fluids and juices into the intestine. This surgery also retains part of the duodenum in the digestive track.

Pros of BPD-DS surgery:
Less invasive than BPD.
Better absorption of nutrients like calcium, iron, and vitamin B12.
The patient can eat better as compared to other weight loss surgeries.
Practically resolved issues of ulcers and dumping syndrome.
Cons of BPD-DS surgery:
Pungent stools and flatulence but less so than with BPD alone.
High risk of contracting chronic diarrhea.
Very high malabsorptive component.

http://www.nawls.com/public/101.cfm?sd=2

PREOP JITTERS

It is very NORMAL, NORMAL, NORMAL to have jitters preop! To assist in finding inner peace with your decision to have WLS consider YOUR CHOICE reflects the responsible, powerful masterful spirit that you are and you're ready to start creating miracles in your life. Taking some time to meditate, journal, pray, use positive affirmations http://www.dailyinspiringquotes.com or http://www.nawls.com/public/department27.cfm or here http://www.unityonline.org/pray_prayersaffirmations.htm etc on your decision.

Writing all the reasons why this is your choice, what your expectations and goals are (*consider those beyond wt loss itself), what you are fearful of.

Those that have goals that are health focused and functionally focused do the best (vs. those that are scale or weight/number focused). I am such a firm believer in not allowing the scale (or hunkametal that it is) to rule or dictate ones life/thoughts/feelings any longer!!!, I agree we want to lose wt but gaining our health and ability to function in life can be far more important than any number the scale can read; otherwise if it never reads the number we think, others say, a chart suggests we fail and that is simply not true!!!

As I have said before in other forums:
"Most of our lives we have set RIGID, UNREALISTIC WEIGHT LOSS GOALS for ourselves that are BOTH UNATTAINABLE and CHRONICALLY DISAPPOINTING and lead to DEVASTATION & the slippery slope of self-sabotage..."

Review the UNDERLYING lifestyle change such as exercise, food choices, self-awareness/monitoring, avoidance of emotional eating, and adherence to living self responsibly in a CONSISTENT way that is the foundation to our long-term success. For me I keep telling myself daily that:*THE GOAL SHOULD NEVER BE A NUMBER*

Consider that happiness and success will NEVER EVER come from an external source (person, object, number on the scale). It can and will ONLY come from internal self-discovery and love. Listening to my BODY/Mind/Spirit/Heart now and though your journey can be most helpful. Many times we are so busy or do not find the 'me' time needed to really connect internally w/ ourselves.

Anxiety is just fear in disguise, ask yourself what are you fearful of? The changes you will go through physically/emotionally/relationship wise, pain, dying, complications, loss of food, fear of failure? Write about them, get them out of your head, make room for them and consider trying to feel them.... The goals you write today and reasons may help now as well as down the road when a complication or stressor or plateau happens, it can re-center you within your self, helping you refocus on the big picture and choice you made, well aware of a few bumps in the road. Deciding to have surgery, being as well informed and educated as possible, having supports (in person groups, online, friends and family) to talk to, to normalize and validate our journey and ourselves is a key as well.

ONLY you know if this is the right thing at the right time for you, anxiety/fear is common and normal, consider embracing the feelings, they are only that feelings they have a beginning/middle/end and serve us well if we listen vs. avoid/repress/stuff them. See this opportunity as one where you can grow. I was motivated but scared as well of dying. A hard decision but one I do not regret making....

I recommend you consider trying to fill your mind with as much optimism and positive thinking as possible! Basically, become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for you to take, and it's not just about weight changing -- it's about life changing. This is why so many of us are challenged by the enormity of the decision.

http://www.livingafterwls.com/Library.html this site has many good articles for preop/postop! Check it out periodically there are many good topics!!!

Maybe use positive thinking such as:
"I AM COMMITTED TO FACE AND RESOLVE THE PROBLEMS OF LIVING" (i.e. no longer be morbidly obese)

"MY SUCCESS DEPENDS UPON MY CHOICES AND MY BEHAVIOR IN THE PRESENT" (i.e. having the surgery, committing to a healthy lifestyle)

"ALTHOUGH I MAY NOT HAVE TOTAL CONTROL OVER WHAT HAPPENS IN MY LIFE, I CAN ALWAYS CONTROL MYSELF AND HOW I RESPOND TO WHAT HAPPENS" (i.e. complications but how I manage them if they happen is up to me).

THIS EMPOWERS YOU NO MATTER WHAT LIFE BRINGS!!!

YES THIS IS NOT THE EASY WAY OUT! It takes extraordinary courage to make the decision and live w/ the choices we make to consciously limit food choices for the rest of our lives (and potentially limit social opportunities built around meals) among all the other potential complications it can bring short or long-term....

There will be plenty of opportunities to grow/change in life as it can be one stressor/problem after another but deciding to keep on keeping on will always help! I will keep you in my thoughts and prayers! You are a warrior and worthy of this opportunity to change your life...Be well.

 Thanks so much for all this amazing information.  I went on all these sites to see if my DR is on them such as ABMS, ABS and ASMBS.  My surgeon isnt on them.  Now I am wondering how could that be and why?  One of the Drs in his practice is listed on the American Society for Metabolic and Bariatric Surgery but not my DR.  What could that mean?  I have an appt with my Dr on Tues so I will ask him many, many questions that you have brought to my attention.  I cant thank you enough for all this info!!! 

Carrie

You're welcome keep us posted!
J~

This is a question that i have also pondered over for a very long time. I have been thinking about surgery for a number of years. As advised by others here on the site DO your research. My cardiologist suggested that I consider lap-band, he gave me a number of reasons.
Then when I went to the orientation meeting and learned more about bypass, I decided I needed to look into this option more thoroughly.

One of my concerns about the band was heightened when watching a episode of BIG MEDICINE that showed Dr's Davis' daughter/ sister having a problem with band slippage.
She had to fly home to Texas for her Dad & Brother to fix it because the doctors where is was didn't know what to do for her. Not everyone has family in bariatric surgery.

BTW- I am also still undecided.

Remember:  KNOWLEDGE is POWER

Wish you success with whichever option you choose.