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Choosing a Weight Loss Operation
Here at the University of Washington, we primarily perform 2 operations for surgical weight loss: the Roux-en-Y Gastric Bypass and the Laparoscopic Adjustable Gastric Band (Lap-Band). Each of these operations has their own advantages and disadvantages and either might reasonably be chosen by individual patients. In unusual circumstances we may also offer other weight loss options, such as the Gastric Sleeve procedure.
The Roux-en-Y Gastric Bypass
The Roux-en-Y Gastric Bypass has two components. First, the stomach is divided just below the esophagus, creating a small pouch about the size of an egg. Because this pouch is small, less food can be eaten at a time and patients will feel full much more quickly. Second, this pouch is connected directly to the small intestine, bypassing the rest of the stomach and the first part of the small intestine.
In most cases we are able to perform a gastric bypass laparoscopically. In a laparoscopic procedure, the operation is performed through several small (1/2 to 1 inch) incisions using a camera and long, thin instruments. In general, pain is less and recovery is faster after laparoscopic surgery than after traditional open surgery. In some cases, such as in some patients who have had prior stomach operations, we may recommend an open gastric bypass. Although short-term recovery may be somewhat slower, long-term results are the same after open and laparoscopic gastric bypass surgery.
The Laparoscopic Adjustable Gastric Band (Lap-Band)
In the Adjustable Gastric Band procedure, a small inflatable silicone band is placed around the top of the stomach, creating a small pouch the size of an egg. This pouch creates a sensation of fullness after eating relatively small amounts of food, thereby reducing caloric intake and resulting in weight loss. Unlike the gastric bypass, the stomach is not divided and no part of the intestine is bypassed. The procedure is usually performed laparoscopically, but may be placed in an open fashion if necessary.
The band can be adjusted to make sure that it is not too tight or too loose and to encourage continued weight loss. To modify the size of the band, its inner surface can be inflated or deflated with a saline solution. The band is connected by tubing to an access port, which is placed well below the skin during surgery. After the operation, the surgeon can control the amount of saline in the band by entering the port with a fine needle through the skin.
Which operation is right for me?
Both the Roux-en-Y gastric bypass and the adjustable gastric band can result in significant, sustained weight loss and improved health. There are significant differences, however, between the operations and in the post-operative care that is required.
In general, the gastric bypass operation is a longer and more difficult procedure with a higher risk of complications such as bleeding, infection, leaks from the bowel, blood clots, and even death. The operation itself takes about 3 hours and involves a 2-3 day hospital stay if done laparoscopically. Late complications after the gastric bypass include bowel obstruction and stenosis, or narrowing of the bowel. Nutritional problems, such as vitamin deficiencies may occur after the bypass operation. You will need monthly B12 supplementation and your doctor will need to monitor your blood work yearly.
After gastric bypass you will need to see us every few months for the first year, then less frequently after that. Gastric bypass surgery is a tool for weight loss and requires your active participation to be successful. This includes compliance with dietary changes, exercise, and close follow-up with us and with your primary physician. We will expect to see you at least once a year for the rest of your life.
The adjustable band operation takes about 90 minutes and may be done as an outpatient or with an overnight stay in the hospital. Early complications include bleeding and infection, but these tend to be less common than after bypass. Late complications may include band slippage requiring re-operation, erosion of the band into the stomach, impaired motility (squeeze) of the esophagus, and dilation (or stretching) of the pouch. Although serious complications such as erosion are rare, minor complications may be more common with the band than with the bypass. This might include pouch enlargement requiring temporary deflation of the balloon or problems with the port requiring replacement.
To get the best results with the band, frequent adjustments are necessary. On average, 6-8 adjustments will need to be made in the first year after banding. This means that weight loss after banding requires frequent and close follow-up and a much more active involvement by you and your surgical team.
Weight loss is more rapid after the gastric bypass, with most weight being lost in the first 18 months. Because of this, other health problems such as diabetes tend to improve more quickly after gastric bypass than after the adjustable band. Early studies suggested that weight loss might be greater following the bypass compared with the band. However, it now appears that weight loss following banding continues out to 4 years. With the band, then, weight loss is slower but seems to eventually catch up with the bypass. The adjustable gastric band is a newer operation than the gastric bypass, and we do not have as much long-term data about it’s effectiveness over many years.
Both the gastric bypass and the adjustable band are very effective tools that can help you lose weight and improve your health. There are many reasons why you might prefer one over the other. For example, young women who wish to have children may prefer the adjustable band, as it can be loosened during pregnancy. On the other hand, those with severe diabetes may wish to have the more rapid weight loss and quicker improvement in diabetes found after gastric bypass. This is a good opportunity to research your options and discuss them with your family and your surgeon.
Once you become a patient at the University of Washington you will receive a handbook with much more detail about the pre- and post-operative care for both Gastric Bypass and Adjustable Gastric Banding.
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