Adam Goldstein, D.O., F.A.C.S.
Gastric Bypass vs. Gastric Band: A Surgeon's Comparison
Are some bariatric surgeons helping obese patients achieve great success with gastric bypass surgery, a procedure that irreversibly rearranges (and deletes a portion) of the gastrointestinal tract? Indeed, those successes are well-documented.
Surgeon Adam Goldstein, D.O., F.A.C.S., concedes that point, because studies conclude that in the long term, gastric bypass patients are able to lose about 10 percent more excess weight than gastric band patients. (He gives his perspective on that 10 percent below.)
But after performing and comparing both types of bariatric surgeries, Dr. Goldstein has chosen the path of doing only gastric band (Lap-Band®) surgeries now that he has joined the Our Lady of Lourdes Medical Center bariatric surgery program. (See details on the band surgery and how it works here.)
That's because the more complex gastric bypass operation carries an increased risk of complications and a mortality risk rate of three-to-10 times higher than that of the band (depending on the study reviewed), he said. His decision to stick with the band has been reinforced by seeing first-hand the severe complications of bypass surgeries done by others.
"The thing is, I can achieve comparable results with the band and not submit the patient to these increased risks," he said. "And if there is a complication, you can remove the band and their anatomy is the same as it was before the surgery."
That lower risk and the relative simplicity of the surgery is prompting more and more patients to choose the band, Dr. Goldstein said. "If there is a problem with the band, you can remove it and the patient's anatomy is the same as it was," he said. "The reversibility is very attractive because patients feel if it does not succeed for them then it can be removed."
The gastric bypass procedure does have one advantage that can not be matched by the band—the time in which weight, especially large amounts of weight, can be lost.
"It takes time for sand to go down an hourglass because it is skinny in the middle and that's the goal of the band. When the patient fills the small stomach area above the band with food, they feel satisfied, they stop eating, and that's it, the meal is over."
"Over the course of the next one to two hours that food will break down and make its way past the narrow ringed area and make its way into the main part of the stomach."
Therefore, the portions they eat are smaller (four to six ounces) than they would normally eat and eventually the decrease in calories causes weight loss.
"If you are 250 pounds overweight then it will take a longer period time to lose weight with the band versus bypass," Dr. Goldstein said. For severely obese patients whose doctors worry about imminent heart attack or other dangers, a bypass may be the best path, he said.
Dr. Goldstein explains the tradeoff to his patients: The band, which is reversible, carries substantially less risk than a bypass, but the bypass can result in quicker loss of large amounts of weight.
The reason for these differences can be found in the simplicity of the band procedure, which merely places a band around the upper portion of the stomach (plus a tube leading to a port in the abdomen) and leaves the rest of the GI tract intact. This produces no immediate—and Dr. Goldstein stresses the word immediate—metabolic change in the patient.
Because gastric bypass rearranges and eliminates a portion of the intestinal tract, it does create substantial change, reducing the body's absorption of ingested material. In some cases, gastric bypass patients with diabetes see the disease go away.
"The research lately has been focused on the bypass operation causing immediate beneficial change in the way the body processes what you eat and processes glucose in the blood stream," said Dr. Goldstein.
"But studies also are being done into the effect of the gastric band on diabetes. One recent paper, published in the New England Journal of Medicine, said that over a two-year period after a band procedure there was a 75 percent elimination or improvement of diabetes. So the overall effect of the weight loss is achieving similar impact on diabetes, but it just takes a bit longer."
Long-term studies show that bypass surgery results in a higher loss of excess weight than the gastric band, but the difference is only 10 percent. Bypass patients average a 70 percent loss of excess weight long term, compared to 60 percent for band patients.
