Many patients who see us in consultation are candidates for either Gastric Bypass or the Lap Band surgery. In such cases, should the patient undergo gastric bypass or Lap Band surgery?

How is this decision made?

Some patients find it difficult to decide which procedure is right for them. This can be a difficult decision and we encourage you to take your time and do your research. Other things that may help you make your decision include: attending support group meetings, talking with past patients, meeting with the dietitian or surgeon and discussing your concerns.

There will be times when you may not have a choice:

*Certain insurance companies will only pay for certain procedures, or
*Certain medical conditions are contra-indicated with certain procedures

With consideration to the above listed suggestions and issues, if you still are having difficulty deciding, consider the following:

If you live far away from the surgeon, will it be difficult to have adjustments?
Do you have a "sweet tooth?" You will have less success with the Lap Band
Are you a heavy snacker? You may have less success with the Lap Band
Are you really scared of the Gastric Bypass? The Lap Band may be a better choice.

The Lap Band requires tremendous commitment and self control. If you chose to eat unhealthy, high fat and high sugar foods, it will be very difficult to lose weight. To help patients make their own best decision about which procedure they should undergo, we offer this table:

Roux-en-Y Gastric Bypass	Lap Band®
Gold standard, time tested	Promising new technology
Complex operation, multiple areas of abdomen involved	Simpler operation, gives lower risk around surgery (less chance of death or prolonged hospitalization)
Rapid weight loss over 3-6 months, settling at final weight 10-16 months after surgery	Slow and steady weight loss, settling at final weight around 2 years after surgery
Deficiency in mineral absorption, requiring long-term supplements	Possible deficiencies due to decreased intake, long-term supplements also recommended
Dumping syndrome (intolerance to sugars and some carbohydrates)	No Dumping syndrome
Not reversible	Sort of reversible
No significant hardware in body	Long term (non-reactive) plastic material in body
	The Lap Band® must be adjusted for best success

Comparing the Procedures

Patients generally have more success with gastric bypass operations than restrictive procedures.

Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12--are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking.

Gastric bypass operations also may cause "dumping syndrome." This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.

Open vs. Laparoscopic Surgery

Open and laparoscopic refer to how abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.

When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4 1/2 to 6 inches, and for men, it is 5 1/2 to 7 inches.

With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures.