Band or Bypass

Hey guys, Dr. Garth here.

The question of what is better band or bypass, is a question I deal with daily. Given the fact that I do both procedures I think I can give you a pretty good perspective.

The gastric bypass has been around a long time and is the gold standard by which we judge all other weight loss procedures. The great advantage of being around for so many years is that we have long term data on the gastric bypass. In fact a recent study reviewed the average excess weight loss 20 years after gastric
bypass and the average was over 50% of the excess weight. Keep in mind that we do the surgery different now and are seeing even better weight loss now. It is true that with the gastric bypass people tend lose a lot of weight quickly, they do tend to gain a little back then stabilize out. I recently reviewed my database and found that my average weight loss 1 yr after surgery was 73% but 2 yrs out it was 68%, so there was a small weight gain.

I hear people talking about people they new who had a bypass and gained all the weight back. This is a highly unusual situation, and I would question whether they truly had a bypass or how the bypass was performed. If it is done incorrectly there is a chance of regaining. We feel an operation is successful if you can lose 50% of your excess weight. The number of bypass patients that do not MAINTAIN this level of weight loss is said to be 10%. So 90% of people have a successful result with bypass.

The band is the new kid on the block. Bands in general have been tried and have failed for many years but the new lap band has advantages over the prior bands: namely the ability to adjust the tightness. The band started in Australia and has been done there since the 90′s. It has only been done in America since 2001. The Australians and the Belgians published data showing that the average weight loss with the band is 60%. The initial studies in America only showed a weight loss in the 30-40%. This seemed much worse than the bypass so at first a lot of weight loss surgeons abandoned the band. It turns out that the problem had to do with the follow up. The thing about the band is that it needs to be carefully adjusted. It is also vital that patients who have a band understand that a band is just a tool. If you think the band will work all by itself you will be disappointed. We cannot make the band so tight that soft foods and liquids cannot get by band, and it turns out most junk food is soft or liquid so you have to watch what you eat.

Since we have been doing more program oriented weight loss combining band with education and support, weight loss is now at about 50-55% on average in America’s top centres. Now remember I said we term weight loss a success if you lose 50%, while the average weight loss is 50%, only about 20% of patients actually reach that 50% level (based on the band company’s own research). Now I am not sure why we chose 50% as success. Studies have shown that just 10% weight loss does wonders for health, but anyway that is the scientific data.

One important thing to note is that the band loses weight slowly. So 1 year out the weight loss may be low but a few years out we find that band patients are still losing while bypass patients may be regaining.

You have to remember both surgeries are just tools. With band patients you have to learn to use that tool immediately, and make the right food choices. With the bypass you have a honeymoon period for the first year or 2 where the weight just falls off, but after that, like the band patient you need to exercise and learn to eat correctly.

In general I find that I can very reliably predict the weight loss of a bypass patient. It is more difficult with the band patient. I usually find that I have band patients that lose a ton of weight, in the 60-70% range, and then some who continue very bad eating habits and no exercise and only lose 20%, which averages to the 50% or so weight loss.

Now complications are certainly an issue. While I feel that I can do the bypass safely there are some serious complications that can happen. There are the risks of leak, bowel obstructions, ulcers, and vitamin deficiency. The band does not have these complications. With the band the band can slip or the band can erode into the stomach. The advantage of the band is that it can just be removed or even just revised. Although complications happen with the band they seem to be less severe than the bypass.

As far as curing disease, that is usually just a function of weight loss. So obviously the more you lose the better your co-morbidities will be. One exception is diabetes, gastric bypass does a much better job curing diabetes. Band certainly helps diabetes but the response to the bypass is fairly dramatic. So in general, if your BMI is over 5o I lean toward gastric bypass, because you just have more to lose. I definitely have done band sin people over 50 and they have done well but this is in general. If your BMI is less than 40 I will usually suggest band because you just do not have as much weight to lose.

If you have diabetes I will usually suggest bypass, but if you have anaemia or are prone to ulcers or have had tumours in your stomach or have a chronic disease or cancer then I will lean to the band.

A lot of information so hopefully that will help.

Garth Davis MD

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