Question:
How do I choose which surgery to have?

My doctor has recommended the lap band surgery for me. I am 5'8" and weigh about 280 lbs., so i have about 130 lbs. to lose. I am wanting to have a safe surgery but I want something that is going to be successful. Does the RNY surgery seem better? How do you choose?    — Jennifer R. (posted on September 17, 2004)

September 17, 2004
The gold standard procedure at the current time is the Roux en Y Gastric bypass whether performed laparoscopically or open. Lap Band was approved by the FDA for use in the US in 1996 and RNY has been performed since the 1960's. Lap band only has short term data in the US that shows at an approx 40-60% excess weight loss. The roux en Y has approximately 60-80% excess weight loss. Safety should be the main concern in all procedures and is increased by a comprehensive preoperative evaluation and consultation with a surgeon well qualified to do all procedures you are considering. At many "experienced" bariatric centers the mortality from roux en y gastric bypass is less than 1%. The mortality for the Lap band is less,but no one can tell you with certainty what the long term outcome of the band will be at this time compared to the roux en y gastric bypass and most long term data is from Europe or Australia. Lap band is pure restriction and there are no specific recommendations even from the company which patients will do best with this type of surgery. It also is a foreign body placed within your body but doesn't divide bowel or stomach. Weight loss is much slower over 2-3 years with frequent follow up for adjustments. The roux en Y weight loss is faster over 1 - 1.5 years. Malabsorption in RNY vs none in Lap Band must be considered. Both should be considered a lifetime procedure even though the Lap band is advertised as reversible. If taken out you would likely regain a significant portion of your weight if not all. No one can tell you what is right for you but you have taken the first step by starting to ask questions. A surgeon may be more specialized in one of the procedures and doesn't do other procedures. If so seek a second opinion from a surgeon who has a large experience with all procedures you are considering, or a third... until you have your questions answered to your own satisfaction. Don't forget to check your insurance and what it covers, unfortunately this sometimes has more to do with which procedure a patient ultimately decides on. Many do not cover the Lap Band. Weighing the risks and benefits of each procedure is ultimately up to you. I hope this helps.
   — selwynca

September 17, 2004
Hi Jennifer, Another alternative is the DS. Its a great WLS. You can read about it at www.duodenalswitch.com or please feel free to join us at the DS forum. Go to communities and scroll down to Duodenal Switch. My best wishes on your upcoming WLS. Lyric
   — Lyric

September 17, 2004
Only you can answer this after you do tons of reading about the post-op life of each surgery. You have to live with the surgery so don't let any doc totally decide for you. You need to look at what your eating habits are now. Are you a volume eater? If so, do you think you can deal with eating a small quantity as long as you are satisfied? If yes, then consider an RNY or Lap Band. If no, then go with the DS as it will allow you to eat more food because of the longer bypass. <p>Will you be anal about taking your vitamins etc. If not, then lap band is your safest (no malabsorption and normal stomach function). If you think you might do okay then an RNY might be the right choice. If you know 100% that you will always comply with your regimine then you would do okay with a DS. Because of the very significant malabsorption associated with the DS you will not have the luxury of skipping a day etc. I'm an RNY with a 150cm bypass and have some minimal problems with being a little low in areas, but truthfully I haven't been as anal as I was, the last few months. If I was a DS, I would likely be quite sick by now. <p>There is no right or wrong surgery. It's whatever is the right one for you and your lifestyle. Do not assume that you can totally change your habits for the rest of your life as very few can. I followed everything to the T for about 9-12 months, and the weight literally fell off, but slowly the old habits have come creeping back. I manage to keep the weight in check but some days I eat total trash food, which I cannot believe after everything I have gone through. But the reality is I will always struggle with my old eating habits and that is why I am very thankful I have a malabsorptive type surgery and the small pouch, although I'm sure it's huge now. For me I do not think the Lap Band would have been the right choice and the DS and it's long bypass/short common channel scared the heck out of me. So the RNY it was. My surgeon does a 1/2 ounce pouch along with the longer bypass of 150cm on anyone with a BMI of 50 or higher. I was a 65.3 and started at 442 lbs. These days I float between 192-197, which is where I am trying to stay. I have my 3rd PS scheduled for Nov 10th which will remove the excess leg skin which likely is about 8-10 lbs. I'd like to go into surgery at about 190-192 and then with the skin removal hang in the 180-185 range for the rest of my life. I'm 5'9. <p>I know that some surgeons feel that doing the lap band is right for someone who only has abut 100 lbs to lose, but the bottom line is not how much you have to lose but what your food motivators and demons are and your eating habits. I know many will say that they have totally changed and if they are over 18 months out and still maintaining that total change then more power to them, but the greater majority of us will always have to deal with food issues. I knew this going in so it hasn't been too big a shock to me, but some days it gets me down that I don't have the brains or the willpower to totally control the eating. I also do not tend to gain from the bad eating, or if I do it's just a few lbs and I can get it right back off, but that's truly not the right way to deal with it. <p>Do tons of research and then decide for yourself!
   — zoedogcbr

September 17, 2004
My suggestion would be to look at long term people. Look at which surgery they started with, where they revised and how many times. Each surgery has flaws and wonderfulness. I've held the hands of two broken lapbands this week and it's heartbreaking, as their chances for revision are very slim now. Their bands are shot and they have had to have them removed. That's not to say it's a bad procedure, just not looking too good to ME right now. I have a distal gastric bypass, which some people find appalling. I would suggest that you lurk here on the Grad list, even tho you cannot speak yet. And on the protein list, simply because you CAN speak and there are some long termers on there, as well. Here are the links: http://groups.yahoo.com/group/Graduate-OSSG and http://groups.yahoo.com/group/OSSG-Protein/
   — vitalady

September 17, 2004
My surgeon does both and reports the bands loss is less, because most RNYers get at least a minor dumping. I could of had the band but opted for the RNY. For ME high calorie liquids would of been way too band friendly:( You can watch the august 2004 archived on line support group meeting at this link with video and audio and see me too near the end. My surgeon dr philip schauer comments on the band vs rny.
   — bob-haller

September 17, 2004
Look back on Sept 13th, there was a similar question. I posted a link that gives an explaination of the different surgery types. Also on this site there is an explaination of the different surgery types, it is in the main entrance page. I am not sure exactly where it is on that page you will just have to look around. Good luck.
   — ChristineB

October 10, 2004
I agree that the RNY is the Gold Standard. I investigated thoroughlyt on this site and others prior to having surgery and found this to be true. I am not cutting on the lap band, but have a sister that has worked in a major hospital here in Louisville Ky, (is an RN) and she has seen 10 pts die after having lap bad surgeries. I have known of 2 people that had the lap band, and had severe complications and ended up having to have them removed within 1 1/2-2 yrs after getting them put on. Do the research, and make the best choice for you. Like someone said before, what eating choices and food demons ect... we have before surgery, we'll still have after surgery and still have to deal with them then. This surgery only changes out tummies, not our brains, (I wish).
   — bufordslipstick