Tuesday, February 12, 2008

Ask Dr. Hect: Gastric bypass surgery or lap band surgery?


Philadelphia, PA
Question: Which is a better procedure, gastric bypass or gastric LapBand surgery?

Answer: Gastric bypass certainly is more effective, averaging 68 percent excess weight loss after two years vs. 37 percent for gastric band surgery. Both procedures show lasting weight-loss benefits.

But there are some post-procedure differences that should be noted: First, gastric bypass surgery requires continual monitoring of levels of iron, Vitamin B12, folic acid, calcium and Vitamin D. Gastric bypass also has been associated with what is known as "dumping syndrome": The small intestine fills too quickly with undigested food from the stomach, causing nausea, vomiting, diarrhea, and shortness of breath.

LapBand patients require tension adjustments, and additional surgeries may be needed. The LapBand procedure may be the better choice for morbidly obese people who are elderly and frail, or for those not needing massive weight loss.

For appropriate surgical candidates, the benefit of either one is clear: Research shows that four years afterward, there is an 86 percent improvement or resolution in diabetes; a 70 percent reduction in the incidence of elevated cholesterol; a 78 percent reduction in the incidence of hypertension; and an 86 percent reduction in the incidence of sleep apnea.

While both procedures can be lifesaving, there is a small risk of death from either - 0.5 percent mortality risk from gastric bypass surgery and 0.1 percent from LapBand surgery. And there are long-term complications (necessitating removal of the gastric band or conversion to gastric bypass) in 15 to 58 percent of patients who have had the LapBand procedure.

Mitchell Hecht is a physician specializing in internal medicine. Send questions to: Ask Dr. H, Box 767787, Atlanta, Ga. 30076. Because of the volume of mail, personal replies are not possible.
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