Lap Band vs Gastric Bypass Surgery

Lap Band Vs. Gastric Bypass

At least 10 peer-reviewed studies have directly evaluated lap band vs gastric bypass.

Here are the takeaways...

Points in favor of gastric bypass surgery

  • More weight loss
  • More favorable improvement of obesity health problems
  • Less likely to fail (i.e. less likely to require conversion to another procedure and less likely to result in insufficient weight loss)
  • Lower re-operation rate
  • Fewer minor/annoying complications
  • No foreign object in body after surgery
  • May lead to a healthier and more balanced diet

Points in favor of lap band surgery

  • Fewer serious complications
  • Lower levels of malabsorption (so lower risk of malnutrition/nutrient deficiency)
  • The procedure is reversible or easily converted into a different type of bariatric surgery (it is worth noting that reversals almost always result in significant weight gain).
  • Lower short-term complication rate
  • Shorter operation time and hospital stay
  • Quicker recovery

Similarities

  • Insulin resistance improvement

The rest of this page dives deeper into the comparison of these two popular procedures, including:

Remember... there is no “one size fits all” bariatric surgery - it’s not a competition of which surgery is best, it’s a competition of which is the best for you.  Either could be more appropriate depending on your situation.

Following are the studies referenced above that directly evaluated lap band vs gastric bypass (use scroll bar to view all studies)…

Summary of Lap Band Vs Gastric Bypass Study Findings Year
Lap Band Vs Gastric Bypass Surgery Study References:  E, F, G, H, I, J, K, L, M, N, O*For simplicity, all acronyms and procedure names have been changed to a common name (i.e. LAGB and Laparoscopic Adjustable Gastric Banding were changed to Lap Band Surgery).
Across multiple sites, individuals with higher BMI and morbidity burden were more likely to receive gastric bypass surgery. Preliminary results suggest that long-term weight loss and certain short-term complications are significantly greater for gastric bypass than lap band procedures, and that lap band procedures are more likely to have 30-day reintervention. Multivariable comparisons adjusting for pre-operative covariates and follow up time will better clarify risks and benefits of these procedures.0 2013
Gastric bypass produces substantially greater weight loss than lap band. Whilst peri-operative complications are greater after gastric bypass, long-term complication rate is higher following lap band.N 2013
Roux-en-Y gastric bypass is associated with better weight loss, resulting in a better correction of some comorbidities than gastric banding, at the price of a higher early complication rate. This difference, however, is largely compensated by the much higher long-term complication and reoperation rates seen after gastric banding.M 2012
Weight loss outcomes strongly favored Roux-en-Y gastric bypass over lap band surgery. Patients treated with lap band had lower short-term morbidity (bariatric surgery complications) than those treated with Roux-en-Y gastric bypass, but reoperation rates were higher among patients who received lap band surgery. Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States.E 2008
Collectively, data clearly point to distinct changes in dietary habits after bariatric operations which markedly differ between gastric bypass and lap band patients. Overall, it is tempting to conclude that gastric bypass operations lead to a healthier and a more balanced diet than lap band implantations.K 2008
Both lap band surgery and gastric bypass significantly improved insulin resistance during the first 3 months following surgery. Both operations generated similar changes in Homeostasis Model Assessment for Insulin Resistance (HOMA IR), although postoperative HOMA IR levels were significantly lower after gastric bypass. These findings suggest that caloric restriction plays a significant role in improving insulin resistance after both lap band surgery and gastric bypass.G 2007
The results of our study have shown that gastric bypass results in better weight loss and a reduced number of failures compared with lap band surgery, despite the significantly longer operative time and life-threatening complications.H 2007
Lap band patients returned to normal activity levels earlier than gastric bypass patient's irrespective of approach. Lap band surgery patients also reported recovering from surgery significantly sooner than open gastric bypass patients. Perceived differences in recovery time between open and laparoscopic gastric bypass patients did not affect their time to resumption of normal activity.J 2007
When patients are matched with a 3-year follow-up according to time of surgery, age, sex and body mass index (BMI), gastric bypass provides superior weight and co-morbidity reduction and can be done without severe complications. However, the lap band surgery is an effective weight loss tool and not every patient wishes to have the gastric bypass.L 2006
Gastric bypass results in significantly greater weight loss than lap band surgery in super-obese patients, but is associated with a higher early complication rate.I 2005
Patients undergoing lap band surgery have shorter operative times, less blood loss, and shorter hospital stays compared with laparoscopic gastric bypass patients. The incidence of major and minor complications is similar; however, morbidity after gastric bypass is potentially greater and the reoperation rate is higher in the lap band surgery group. Early weight loss is greater with gastric bypass, but the difference appears to diminish over time.F 2004

Lap Band Vs Gastric Bypass Surgery: Deeper Dive

Lap band and gastric bypass are both equally life-changing procedures. Each requires significant preparation prior to surgery, and for each to be successful, your diet and exercise habits will need to change forever.

The following chart compares all five aspects of surgery, including…

Lap Band vs Gastric Bypass Procedure

lap band vs gastric bypass


Adjustable Gastric Band (lap band surgery) Roux-en-Y Gastric Bypass Surgery
References:  A
Operating time Around 1 hour 2 to 3 hours
Implanted surgical device  Yes (banding system, including band, tube and access port) No
Rearrangement of digestive system No Yes
High malabsorptive component (substantially less vitamins and nutrients are absorbed after surgery) No
(any malabsorption after lap band surgery is due to less food being eaten and therefore the potential of not eating enough nutrients)
Yes
(a significant part of the digestive system is bypassed, resulting in malabsorption)
Reversible Yes No
(technically yes, but given the difficulties and complications you should consider it irreversible)
Contraindications are similar (conditions that may prevent you from having the surgery)A Inflammatory diseases of the gastrointestinal tract, including severe intractable esophagitis, gastric ulceration, duodenal ulceration, or specific inflammation such as Crohn’s disease. 

Severe cardiopulmonary diseases or other serious organic disease which may make patients with these conditions poor surgical candidates.

Potential upper gastrointestinal bleeding conditions such as esophageal or gastric varices or congenital or acquired intestinal telangiectases.

Portal hypertension

Congenital or acquired anomalies of the GI tract such as atresias or stenoses.

Patients who have/experience an intra-operative gastric injury during the implantation procedure, such as a gastric perforation at or near the location of the intended band placement.

Cirrhosis

Chronic pancreatitis

Alcohol and/or drug addiction

Non-adult patients (patients under 18 years of age). Bariatric surgery may or may not be appropriate for people under 18.  See our Adolescent Bariatric Surgery page for more information.

Patients who have an infection anywhere in their body or where the possibility of contamination prior to or during the surgery exists.

Patients on chronic, long-term steroid treatment.

Patients who are unable or unwilling to comply with dietary restrictions, which are required by these procedure.

Allergy to materials contained in the system or a pain intolerance to implanted devices. (primarily refers to adjustable gastric banding)

Patients or family members with a known diagnosis or pre-existing symptoms of autoimmune connective tissue disease such as systemic lupus erythematosus or scleroderma.

Pregnancy: Placement of the adjustable gastric banding system is contraindicated for patients who currently are or may be pregnant. Patients who become pregnant after band placement may require deflation of their bands. See our Pregnancy after Weight Loss Surgery page for more information.
Back to top of Section ( Lap Band vs Gastric Bypass Charts )

Surgery Results: Lap Band Vs Gastric Bypass

The following chart compares several aspects of life after each procedure, including weight loss, success rates and health improvement...


Adjustable Gastric Band (lap band surgery) Roux-en-Y Gastric Bypass Surgery
References:  B, C
Amount of long-term weight lost (average) Around 50% lost on average, but highly variable from patient to patient (could range from less than 25% to more than 80%) 60 to 65%
“Honeymoon period” (period of rapid and significant weight loss) No Yes – first 6 to 9 months following surgery
Speed of weight loss Up to 3 years to reach lowest weight Much faster – reach low point within the first year to 18 months, then gain a little back over time
Long-term success Anywhere from 60 to 85% of patients succeed with the lap band. Determinants of lap band surgery failure include inadequate weight loss and complications that require removal of the band. As high as 90% of patients have a successful result. Research suggests that gastric bypass may result in as much as 28% more weight loss than gastric banding.B Patients usually gain some weight back after reaching their low point.
Impact to feeling of hunger Less impact because there’s no hormonal effect (i.e. ghrelin levels) More – ghrelin and other hormones that create the feeling of hunger are reduced
Impact to tastes Probably no change Foods tastes different to some people afterwards
Co-morbidity (obesity health problems) improvement or resolution Less favorable, but still impressiveC More favorable
Back to top of Section ( Lap Band vs Gastric Bypass Charts )

Complications & Side Effects: Lap Band Vs Gastric Bypass

Every weight loss surgery procedure comes with its own set of challenges. Following is how gastric bypass and lap band stack up...


Adjustable Gastric Band (lap band surgery) Roux-en-Y Gastric Bypass Surgery
Serious complications Very few because not changing the anatomy of the digestive system is not changed More possible with bypass because it's a more complicated surgery, but still has a relatively low percentage (especially notable considering the prevalence of significant co-morbidities in most patients)
Minor complications, annoying ongoing problems More likely Less likely
Long-term complications More likely Less likely
Risk of Malnutrition and Vitamin Deficiency Lower, but bariatric vitamins will still need to be taken Higher – must take supplements for the rest of your life
Dumping syndrome No (remember that dumping syndrome may be a good thing in terms of keeping your diet on track)  Yes
Impact to smokers (should stop smoking as a part of your lifestyle change either way) Lower Higher - WILL CAUSE an ulcer in your pouch
Likelihood of reoperation (an additional surgery to correct an issue) Higher Lower
Bowel function changes (the most common for each surgery) Constipation

Difficulty swallowing (if too much food is eaten, food is eaten too quickly or is not chewed well enough)

Diarrhea or loose stools
Constipation

Difficulty swallowing (if too much food is eaten, food is eaten too quickly or is not chewed well enough)


Complete list of complications, side-effects & risks See our Bariatric Surgery Complications page. It provides a full list, definitions, treatments, a comparison of the most commonly performed surgeries and ways to reduce your risk.
Back to top of Section ( Lap Band vs Gastric Bypass Charts )

Long-term Patient Responsibility: Lap Band Vs Gastric Bypass

Weight loss surgery is only a tool. The majority of the work towards long-term weight loss and health improvement will need to be done by you.

Here's a high level comparison of long-term follow up behaviors after each procedure (follow the links for more information)...


Adjustable Gastric Band (lap band surgery) Roux-en-Y Gastric Bypass Surgery
Follow-up doctor visits More – must have up to 10 or more band adjustments to get the level of restriction “just right” Fewer – follow up visits are “check ups”
Bariatric vitamins Fewer, but still necessary More – procedure has malabsorptive component
Exercise for Bariatric Surgery Patients The same is required for both over the long-run – see our Exercise section for requirements.
Bariatric Diet The same bariatric diet is also required for both surgeries, although you will need to pay closer attention to malnutrition risks after gastric bypass surgery. See our Bariatric Diet section for all of the details.
Back to top of Section ( Lap Band vs Gastric Bypass Charts )

Financial Considerations - Lap Band Vs Gastric Bypass

Health outcomes should be the primary driver behind the procedure you choose. But costs are an essential element in determining whether you'll be able to move forward with surgery.

Follow the links in this overview to learn more about each element...


Adjustable Gastric Band (lap band surgery) Roux-en-Y Gastric Bypass Surgery
References:  D
Cost
(assuming no complications)
Less – $10,000 to $25,000

See our Cost of Lap Band Surgery page for more detailed information.
More – $15,000 to $35,000 (largely due to more hospital days being requiredD)

See our Cost of Gastric Bypass Surgery page for more detailed information.
Insurance Insurance coverage for weight loss surgery differs by country and region. But if your insurance does cover bariatric surgery, both lap band and gastric bypass are likely to be covered.

See the following pages depending on your country:
Keep in mind that a good local bariatric surgery clinic should help you verify your insurance coverage for free.
Financing Available for both. Our Financing Bariatric Surgery page explains all of the options along with ways you may be able to get the procedures for a reduced cost.
Back to top of Lap Band vs Gastric Bypass

In-Depth Review of Lap Band and Gastric Bypass

We have entire sections of our web site devoted to both gastric bypass and lap band surgery. Go there now for more research on each…

Hear It Straight from the Source... For Free

Most surgeons offer free seminars and/or free one-on-one consultations that will help you evaluate lap band vs gastric bypass and other procedures along with their office's specific results.

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

Be sure to choose a surgeon that performs BOTH lap band AND gastric bypass surgery to ensure that you're getting a fair representation of each procedure.

Back to top of Lap Band vs Gastric Bypass

Lap Band Vs Gastric Bypass Vs Other Types of Bariatric Surgery

Lap band and gastric bypass, along with gastric sleeve surgery, are the most commonly performed bariatric procedures in the United States, but other surgery types can be just as effective for different reasons.

Patient Perspectives: Gastric Bypass Vs Lap Band Surgery

Click here to read the dialogue between a lap band patient interested in a conversion to gastric bypass and two other patients (one gastric bypass and the other lap band) who each have had successful long term outcomes.

The following pages provide comparisons and links to specifics for each procedure…

Ultimately, you’ll need to partner with good bariatric doctors to determine which is best for you. After you have completed your research on obesity and bariatric surgery, we will help you find, interview and choose the best surgeon on our Bariatric Doctors & Bariatric Weight Loss Center page.

Back to top of Lap Band vs Gastric Bypass

Did this page help you? Please Like, +1, Share or Comment...

New! Comments

Have your say about what you just read! Leave a comment in the box below.


[Last editorial review/modification of this page: 4/16/2014]

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More