There are so many places to learn about weight loss surgery.  It can be difficult and overwhelming to sort through the information available in search of unbiased facts.  Since you've found the Banded Living community, you may already know that you are interested in lap band surgery, or you may be in the process of evaluating all of your options.

The purpose of this section is to give you an overview of the weight loss surgeries currently available so that you can work with your doctor to make an informed decision in answering  the questions:

1.    Is weight loss surgery for me?

2.    Which weight loss surgery is best for me?

There are no guarantees with any of these surgeries.  All of these surgical procedures have risks.  Be sure to discuss the risks vs.  benefits with your doctor  based on your unique situation.

Most of this information is based upon the National Institute of Health, NIH Publication No.  08- 4006, March 2009 entitled "Bariatric Surgery for Severe Obesity".  Specific information about the LAP-BAND® system comes directly from the manufacturer's website.  You can find links to these sites at the bottom of this article.

According to the US National Institute of Health (NIH), weight loss surgery is an option for patients with extreme obesity for well-informed and motivated patients who have clinically severe obesity defined as:

• BMI greater than or equal to 40 or
• BMI greater than or equal to 35 and serious comorbid conditions

There are four types of operations that are common­ly offered in the United States:  adjustable gastric band (AGB) or Lap Band, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS) and vertical sleeve gastrectomy (VSG).  Each has its own benefits and risks.  To select the option that is best for you, you and your physician will consider that operation's benefits and risks along with many other factors, including BMI, eating behaviors, obesity-related health conditions and previous operations.

Adjustable Gastric Band (LAP-BAND^® System, REALIZE® Band), and Others

Adjustable Gastric Band (AGB), commonly referred to as lap band works primarily by decreasing food intake.  Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb.  The outlet size is controlled by a circular balloon inside the band that can be inflated or deflated with saline solution to meet the needs of the patient.

According to the manufacturer of the LAP-BAND® system long-term studies indicate that at three years and beyond, weight loss with adjustable gastric banding is comparable to the roux-en-Y Gastric Bypass. 

©2009 Allergan, Inc.,

RYGB = Roux-en-Y gastric bypass

LAGB = Laparoscopic adjustable gastric banding

Average excess weight loss is comparable over time.

*Laparoscopic adjustable gastric banding using the LAP-BAND^® System and another adjustable gastric band.  Comparison is based on pooled data from 43 peer-reviewed reports involving at least 100 patients at entry and providing at least 3 years of postoperative data.  Data at the five-year point is reflective of N=176 patients for RYGB and N=640 patients for LAGB.⁴

Roux-en-Y Gastric Bypass

Gastric bypass (also known as the Roux-en-Y) is a combination procedure using both restrictive and malabsorptive elements meaning that you absorb fewer nutrients and calories.  It works by restricting food intake and by decreasing the absorption of food.  Food intake is limited by a small pouch that is similar in size to the adjustable gastric band.  In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum and upper intestine from contact with food by routing food directly from the pouch into the small intestine.

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.  Gastric bypass is non-adjustable and has increased risk of post operative complications.

 Biliopancreatic Diversion With a Duodenal Switch

BPD-DS, usually referred to as a "duodenal switch, " is a complex bariatric operation that principally includes 1) removing a large portion of the stomach to promote smaller meal sizes, 2) re-routing of food away from much of the small intestine to partially prevent absorption of food, and 3) re-routing of bile and other digestive juices which impair digestion. 

In removing a large portion of the stomach, a more tubular "gastric sleeve" (also known as a vertical sleeve gastrectomy, or VSG) is created. 

The smaller stomach sleeve remains connected to a very short segment of the duodenum, which is then directly connected to a lower part of the small intestine.  This operation leaves a small portion of the duodenum available for food and the absorption of some vitamins and minerals.

However, food that is eaten by the patient bypasses the majority of the duodenum.  The distance between the stomach and colon is made much shorter after this operation, thus promoting malabsorption.  BPD-DS produces significant weight loss.  However, there is greater risk of long-term complications because of decreased absorption of food, vitamins and minerals. 

Vertical Sleeve Gastrectomy

Vertical Sleeve Gastrectomy (VSG) historically had been performed only as the first stage of BPD-DS (see above) in patients who may be at high risk for complications from more extensive types of surgery.  These patients' high risk levels are due to body weight or medical conditions.  However, more recent information indicates that some patients who undergo a VSG can actually lose significant weight with VSG alone and avoid a second procedure.  It is not yet known how many patients who undergo VSG alone will need a second stage procedure.  A VSG operation restricts food intake and does not lead to decreased absorption of food.  However, most of the stomach is removed, which may decrease production of a hormone called ghrelin.  A decreased amount of ghrelin may reduce hunger more than other purely restrictive operations, such as gastric band.  Since a portion of the stomach is removed the sleeve gastrectomy is permanent.

Comparing Lap Band Surgery to Gastric Bypass

As of 2010, the two most popular weight loss surgeries in the US are Lap Band and Gastric Bypass.  According to the manufacturer of the LAP-BAND® system, below is a side by side comparison of the two surgeries.

Are you a candidate for lap band surgery?

According to the manufacturers of the LAP-BAND^® Systems, you may be a candidate if:

• Your Body Mass Index (BMI) is at least 40, or
  • your BMI is 35 or higher with one or more obesity-related health condition.
  • you are at least 100 pounds overweight.
• You are at least 18 years old.
• You have been overweight for more than 5 years.
• Your serious weight loss attempts have had only short-term success.
• You are not currently suffering from any other disease that may have caused your excess weight.
• You are prepared to make major changes in your eating habits and lifestyle.
• You do not drink alcohol in excess.
• You are not currently pregnant. (Note: If you become pregnant after having this procedure, the band can be adjusted for the duration of your pregnancy.)

Also Consider

There are no guarantees with any of these surgeries.  All of these surgical procedures have risks.  Be sure to discuss the risks vs.  benefits with your doctor based on your unique situation.

For more information and to find links to the NIH and manufacturer's websites (Click Here)