LAP-BAND Forum

Obesity Treatment Options
Millions of Americans turn to diet, fitness and medication first to treat their obesity. Unfortunately, studies indicate that these people will not achieve long-term weight loss through dietary and behavior modification regimens alone. Morbidly obese people have an even greater challenge when it comes to sustaining weight loss and resolving their health conditions. Surgery may remain the best hope for these individuals to lose weight and keep it off.

Non-Surgical Treatments
The most common weight-loss approach is to eat less, eat sensibly, and exercise more. However, many who lose weight using these tactics quickly regain it when the diet ends, which leads to more dieting, replacing meals with special drinks, or taking diet pills. The cycle of losing weight and gaining it back is called the ?yo-yo effect.? While temporary weight loss can help, the yo yo effect can also make it harder to lose weight in the future. The National Institutes of Health report that 90% of the people who participate in diets and weight-loss programs do not lose significant and sustained weight.

Morbidly obese individuals may want to strongly consider weight-loss surgery when other therapies have failed.

Surgical Treatments 
If non-surgical methods have not helped you lose weight and keep it off, you still have another option. Studies demonstrate that weight-loss surgery, as compared to non-surgical treatments, yields the longest period of sustained weight loss in patients who have failed other therapies.  But keep in mind that a positive attitude, self discipline and planning ahead are key to the success of the surgery. Surgery can help you achieve your long-term goal only if you are ready for the commitment to losing weight and keeping it off.

There are several categories of obesity (bariatric) surgery:

• Restrictive - reduces the amount of food the stomach can hold but doesn?t interfere with normal digestion of food and nutrients.
• Malabsorptive - shortens the digestive tract to limit the number of calories and nutrients that can be absorbed.
• Combination - restricts the amount of food the stomach can hold and reduces the number of calories absorbed by altering the digestive tract.
  

Vertical Banded Gastroplasty
Vertical Banded Gastroplasty (VBG) is a restrictive procedure. The surgeon uses staples to make a small stomach pouch,thereby reducing the amount of food the stomach can hold. When your stomach is able to hold less food, you feel full sooner. At the same time, the stomach digests nutrients and calories in a normal way.

Advantages

• Nutrients and vitamins are fully absorbed
• Simpler procedure than the Gastric Bypass or Biliopancreatic Diversion (BPD)
• Lower risk of leakage or intestinal obstruction as compared to Gastric Bypass and BPD
• Lower mortality rate than Gastric Bypass or BPD

Disadvantages

• Rarely performed with minimally invasive approach
• Requires cutting and stapling of stomach
• Slower initial weight loss than Gastric Bypass and BPD
• Non-adjustable
• Staple line disruption shortly after surgery can result in leakage, infection and even death
• Staple line disruption at a later time results in weight regain
• Extremely difficult to reverse

Biliopancreatic Diversion
Biliopancreatic Diversion (BPD) is a malabsorptive procedure and is a more extreme alteration of the digestive process. Roughly three-fourths of the stomach is removed,and the stomach pouch is connected to the final segment of the small intestine. By diverting food through this new "limb," the nutrients are separated from the bile and pancreatic enzymes that would break them down. As a result, BPD greatly reduces nutrient absorption and caloric intake.

Advantages

• Greatest amount of initial weight loss due to the high levels of malabsorption
• Allows larger meals because of larger stomach pouch
• Higher total average weight loss reported than with VBG, Gastric Bypass or LAP-BAND® System

Disadvantages

• Requires cutting and stapling of stomach and bowel
• More operative complications than with LAP-BAND® System, VBG or Gastric Bypass
• Portion of digestive tract is bypassed,reducing absorption of essential nutrients
• Requires lifelong monitoring for protein malnutrition, anemia and bone disease
• Increased risk of intestinal irritation and ulcers
• Non-adjustable
• Extremely difficult to reverse
• ?Dumping syndrome? can occur
• Highest mortality rate as compared to other procedures

Gastric Bypass
Gastric Bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements. With this surgery, 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. The result is that you cannot eat as much and you absorb fewer nutrients and calories.

Advantages

• Rapid initial weight loss
• Minimally invasive approach is possible
• Longer experience in the U.S.
• Higher total average weight loss reported than with LAP-BAND® System or VBG

Disadvantages

• Cutting and stapling of stomach and bowel are required
• More operative complications than with LAP-BAND® System
• 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 than LAP-BAND or VBG procedures

LAP-BAND® System Adjustable Gastric Banding
The LAP-BAND® System adjustable gastric banding procedure restricts the amount of food the stomach can hold by placing an inflatable silicone band around the upper part of the stomach. The new, small upper stomach pouch limits the amount of food that can be consumed at one time, and an narrowed stomach outlet increases the time it takes for the stomach to empty. The subsequent reduction in food intake results in weight loss.

Advantages

• 10 times lower short-term mortality rate than
  gastric bypass 1
• Minimally invasive surgical approach
• No stomach stapling or cutting, or intestinal re-routing
• Adjustable and reversible
• Steady, healthy weight loss
• Low malnutrition risk

Disadvantages

• Slower initial weight loss than Gastric Bypass or BPD
• 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 

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References:

1. Executive Summary: Laparoscopic adjustable gastric banding for the treatment of obesity (update and re-appraisal). The Australian Safety and Efficacy Register on New Interventional Procedures - Surgical (ASERNIPS) 2002.