Gastric Banding vs. Bypass

[VanDiemen]

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Hey everyone, here's a question about bariatrics:

From what I've seen so far, it seems that Banding is a far superior option to bypass. The only downside is that it causes more gradual weight loss and that it has a potential for needing the band to be readjusted. However, this seems to pale in comparison to the myriad of disadvantages with Bypass surgery: all those nutritional problems, the fact that it's not really reversible, an just an overall higher morbidity and mortality rate.

Why hasn't Banding completely overtaken Gastric Bypass? What am I missing here?

 

[goldenwest]

Interesting video on the topic including other type of treatment:

http://www.or-live.com/vanderbilt/2320/

 

[Winged Scapula]

The potential for weight loss is greatest with the RNYGB. The combination of a restrictive and malabsorptive procedure make it more successful in terms of weight lost than a purely restrictive technique like banding.

Banding is simply not effective for the largest patients in whom the risks of the RNYGB are worthwhile given the morbidity of their weight. These patients are on the fast track to an early death due to their DM, CAD, HTN, etc. and the risk of a bypass is far less than the potential benefits.

IMHO, the Band is best for people who really don't have *that much* weight to lose.

 

[opr8n]

Hey everyone, here's a question about bariatrics:

From what I've seen so far, it seems that Banding is a far superior option to bypass. The only downside is that it causes more gradual weight loss and that it has a potential for needing the band to be readjusted. However, this seems to pale in comparison to the myriad of disadvantages with Bypass surgery: all those nutritional problems, the fact that it's not really reversible, an just an overall higher morbidity and mortality rate.

Why hasn't Banding completely overtaken Gastric Bypass? What am I missing here?

hmmm just coming off my bariatric rotation . .so . .

banding is not the end all be all and savior of bariatrics
like wingedscapula, its best for people who dont have that much weight to lose, ie bmi <50 and some would say even less than that
The band also requires 9 adjustments on avg per year, and thats alot of followup visits, plus the patients can still eat past it, ice cream, nondiet soda and chips will go right through and you will lose NO weight
It makes you feel full, so you must make the decision NOt to eat

The RNY combines the restrictive and malabsorptive which makes the operation more durable and on more cruise control, yes you have more probklems with vitamin deficiencies, but the weight loss is more long term and consistent

Studdies show that RNY is superior to band at 1 year for WL but by 2-3 years there is no difference (lose 60-70% of excess weight)

The BPD/DS is the operation to lose alot, but without vitamins, those poeple die

And. . . you heard it herew first . . . (well not really)
but IMHO the Gastric sleeve resection will take over the band in popularity in the next 10 years.
If i needed a bariatric operation, i would get a sleeve

 

[ESU_MD]

band vs bypass.

very similar to stent vs cabg

a band is a quick and simple way to get quick weight loss. requires alot of postop adjustments (much like cardiac stents!)


lap band is often "sold" to the pt without proper informed decision making process. the surgery takes ~30mins, the hardest part is sewing the adjustment port onto the fascia through 8 inches of blubber. plus you can train your nurse to adjust it in the office AND charge for it. the real hardcore guys only do bands and ONLY take cash- no insurance.

patients like it because it is easy and lower risk. it can actually be done outpatient but is more lucrative for the hospital (DRG) to stay overnite. it seems every obese person is seeking the magic procedure to reverse a lifetime of eating mcdonalds

personally I think the roux y bypass is the best for most obese people and is pretty much a very low risk procedure nowdays in centers of excellence.

 

[jhonny depp]

There is no real consensus as to which technique is the best. RYGB has an established track record longer than that of any other surgery. It definately produces greater weight loss at all times as compared to lap band procedure.
The mortality of lap band procedure is lower than that of RYGB as well as the morbidity.
Also earlier there was a concern of band slippage in Banding but with the arrival of newer bands that might not be a concern any more.

 

[VanDiemen]

Do people ever combine lap banding with liposuction? Or is this a totally ridiculous proposition? Perhaps a person could get a lap band and then receive liposuction from a plastic surgeon to remove some fat deposits instantly? This may lead to a very strange look for the patient though.

On another note, when a patient sees a plastic surgeon after massive weight loss to cut away excess skin, is there a danger of the patient regaining weight and then having their skin actually tear or become thinner than normal because of the new weight gain?

 

[opr8n]

Do people ever combine lap banding with liposuction? Or is this a totally ridiculous proposition? Perhaps a person could get a lap band and then receive liposuction from a plastic surgeon to remove some fat deposits instantly? This may lead to a very strange look for the patient though.
quote]
this dosent make sense, lipo is a sculpting procedure, there is no sculpting that can help a person with a bmi of >50
Plus the whole point of the band is not cosmetic, its to chnage the lifestyle of the person, change their eating habits, and eventually effect their whole body weight not just the subq fat
remember males carryu most of their fat inside th abdomen

On another note, when a patient sees a plastic surgeon after massive weight loss to cut away excess skin, is there a danger of the patient regaining weight and then having their skin actually tear or become thinner than normal because of the new weight gain?

most people who get pannics, donmt regain weight, and if they do their skin stretches

 

[VanDiemen]

thanks for the replies everyone. I found an article that seems to echo what you all are saying

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum