January 8, 2010
Dear Mayo Clinic:
Lately I have seen a lot of advertisements for lap band surgery for weight loss. How is this different from bariatric surgery, which I don't hear as much about lately? Does it work? What are the dangers?
Bariatric surgery is a general term used to describe operations that help a person lose weight more consistently and effectively. The two most common types of bariatric surgery performed in the United States are adjustable gastric banding — sometimes called lap band surgery — and gastric bypass surgery.
In general, adjustable gastric banding is safe, and serious complications are uncommon. Gastric banding helps people lose weight by restricting the amount of food they can eat. But it's not a stand-alone weight loss solution. For the procedure to be effective, people must be carefully screened to ensure they are good candidates for gastric banding. Follow-up care, along with exercise and healthy eating, also are key to long-term weight loss for people who undergo adjustable gastric banding.
Adjustable gastric banding involves placing a small, inflatable band around the upper part of the stomach to restrict the amount of food that the stomach can hold. The band is filled with fluid that can be added or removed as needed through a small tube (port) placed under the skin. Fluid can be added to constrict the stomach if the band isn't tight enough and allows in too much food. Or, fluid can be removed if the band is too tight and is causing problems such as vomiting.
In gastric bypass surgery, the surgeon staples the stomach to make a small pouch and then connects the pouch to the small intestine, creating a passage (bypass) around most of the stomach, as well as the first section of the small intestine (duodenum).
Both procedures limit the amount of food that can fit in the stomach. Also, after both procedures, people feel full much sooner than normal, which helps decrease the amount of food they eat. One of the noticeable differences between adjustable gastric banding and gastric bypass — and the one frequently talked about in advertising for gastric banding — is that gastric bypass surgery usually requires a two-day hospital stay, whereas adjustable gastric banding can be done as an outpatient procedure.
Adjustable gastric banding is a low-risk procedure that's less complex than gastric bypass surgery. But as with any medical procedure, complications are possible. With adjustable gastric banding, complications can include infection of the band or the port, and movement of a portion of the stomach — that's supposed to be below the band — up through the band (slippage). The most serious complication associated with adjustable gastric banding is erosion of the band. This occurs when the band works its way inside the stomach, usually as a result of an infection or ulcer. Erosion is very rare, however, occurring in less than 1 percent of gastric banding cases.
Adjustable gastric banding can be an effective way to help people lose weight. It's not for everyone, though. First, if you're considering this procedure, be aware that people who have adjustable gastric banding generally have a slower rate of weight loss than those who have gastric bypass. There is nothing wrong with this, but it is something to consider prior to undergoing the surgery. Average weight loss is about one-third to one-half of a person's excess weight.
Like all bariatric procedures, gastric banding is intended for people who have a body mass index (BMI) of 40 or above or for those who have a BMI between 35 and 40 with a serious weight-related health problem, such as diabetes, high blood pressure or heart disease. In addition, this surgery isn't recommended for people who have certain medical conditions, such as Crohn's disease, large hiatal hernias or connective tissue disorders.
Finally, adjustable gastric banding isn't a cure-all. Follow-up care is critical because all patients need some adjustment of the band after surgery to ensure optimal weight loss. Even after having this operation, patients still need to consistently make good food and exercise choices in order to lose weight. In essence, gastric banding provides people with an opportunity to consistently take in a smaller amount of calories while they're moving forward with the other healthy steps that are necessary to lose weight.
— James Swain, M.D., Gastroenterologic and General Surgery/Director of Bariatric Surgery, Mayo Clinic, Rochester, Minn.