Re: Lapband vs. G.I. Bypass

[Guest guest]

It always makes me pause when people speak of these matters as if

they were questions of opiion, not questions of fact. Here are the

facts:

Weight-loss surgeries acoomplish the goal by two major means:

restriction and malabsorption. Restriction means the amount of the

stomach and intestines that are involved in digestion are physically

limited and restricted. Malabsorption refers to the fact that such

restriction changes the absorption of nutrients from what you eat,

also resulting in weight loss.

There are a number of different procedures. Some are reversible,

some are not. Also, some restrict more and malabsorb more than

others.

Roux-en-Y gastric bypass surgery, now by far the commenest, whether

performed laparascopically or as an open-body (i.e., large surgical

wound) procedure, is not reversible. Because RNY therefore makes

permanent, irreversible changes, a persistent but shrinking minority

of the medical community is philosophically opposed to RNY.

Belly-band surgeries, whether vertical or not, are now all done

laparascopically, hence the common term " lap-band " . Not only are lap-

band surgeries reversible, most are at some point, so if you sign up

for lap-band, you're signing up for at least two WLS's. Lap-bands

are less restrictive (they " compress-off " - rather than

RNY's " stapling-off " - less of your stomach) and less malaborptive

(because the only malabsorption is exactly proportional to the

stomach restriction, unlike RNY, which is much more malabsorptive

because of the bypass of the first section of your small intestine,

which is where much nutrient absorption takes place; hence the need

for vitamin and mineral supplements to a much greater degree for rNY

patients than lap-band patients) than RNY procedures. They are

DESIGNED that way - less weight loss, slower weight loss, and more

chance for regain.

MOST IMPORTANT FACTS!!!!! Despite the apparent appeal of lap-band,

there is NO POSSIBLE ROOM FOR DOUBT. Lap-band is less effective and

has a higher rate of complications and weight regain than RNY.

Surprisingly, this is true even if you restrict the comparison to

between lap-bands and open RNY's. Last important fact: if you have

suffered from gastrointestinal disorders essentially unrelated to

obesity, it may be medically advisable to have a lap-band procedure

rather than RNY, and there may be other factors that mitigate for

lap-band instead of RNY, so it's not just a matter of medical

philosophy re WLS, your doctor may have a serious medical reason to

give you lap-band instead of RNY. If it is not obvious, let me tell

you, any medical reason your doctor has is MUCH more important than

any philosophical or emotional reason you think you have in

opposition.

IMO, within five years, over 90% of all WLS will be laparoscopic

RNY's, and for damn good reason. I think anyone going to this much

trouble would generally be foolish to do anything other than

laparoscopic RNY.

BTW, I had serious coronary artery disease, congestive heart

failure, and, as it turned out, Stage IV squamous cell cancer when I

had my lap RNY on 2/2/06. Even with those serious conditions, the

superficially much more complex and irreversible RNY was the best

choice for me. It almost certainly is for you, too, no matter how

many happy stories you hear from lap-band patients. DO NOT minimize

the role your own capacity for self-discipline has played in your

need for WLS in the first place. When you consider that next to the

weight-regain statistics for lap-band patients, ask yourself if your

self-esteem could survive what you go through for a lap-band (just

as demanding a pre-op regimen as for RNY), followed by regaining

much of the weight lost.

Randy

>

> I was told by my Parkshadeland's KP PCP that the lapband procedure

is

> not as effective as the GI Bypass...as far as losing the excess

weight

> and keeping it off long-term. Have any of you heard similar

> statements?

>