Lap Band vs Gastric Bypass Surgery
The following analysis of lap band vs gastric bypass surgery reveals positives and negatives for each procedure. Remember that there is no “one size fits all” bariatric surgery. Either could be more appropriate depending on your situation...
- Lap band surgery vs gastric bypass surgery
- Studies that directly compare the two & Arguments for each
- How do they compare with other procedures?
Lap Band Vs Gastric Bypass Surgery
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…
- Procedure
- Surgery Results
- Complications & Side Effects
- Long-term Patient Responsibility
- Financial Considerations
Lap Band vs Gastric Bypass Procedure
| 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. |
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Surgery Results
| 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 | ||
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Complications & Side Effects - Lap Band vs Gastric Bypass
| 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. | |
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Long-term patient responsibility
| 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. | |
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Financial Considerations - Lap Band vs Gastric Bypass
| Adjustable Gastric Band (lap band surgery) | Roux-en-Y Gastric Bypass Surgery | |
|---|---|---|
| References: D | ||
| Cost (assuming no complications) |
Less – $10,000 to $25,000 | More – $15,000 to $35,000 (largely due to more hospital days being requiredD) |
| Insurance | If your plan
covers bariatric surgery, both lap band and
gastric bypass should be covered, but the approval process can be
extremely time-consuming and difficult. However, a good hospital-based bariatric surgery program, while preparing the patient physically and psychologically for surgery, will also help to minimize insurance approval issues. See our Bariatric Surgery Insurance page ( includes information about gastric bypass and lap band insurance ) for help. |
|
| 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. | |
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Lap Band Vs Gastric Bypass Direct Studies & Arguments for Each Procedure
Eight studies have been commissioned to directly compare lap band vs gastric bypass surgery. We’ve taken the conclusions from these studies and pulled out the advantages found for each surgery to help you decide which is a better fit for your situation.
Remember, it’s not a competition of which surgery is best, it’s a competition of which is the best for you.
(Further down the page you'll find links to in-depth reviews of both lap band and gastric bypass surgery.)
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 reoperation 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
Following are the 8 studies that directly evaluated lap band vs gastric bypass (click here to skip past the chart)…
| Summary of Study Findings | Year | ||
|---|---|---|---|
| References: E, F,
G, H, I, J, K, L, M *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). |
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| 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 | ||
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 teach you about your options and their office's specific results.
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.
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Lap Band Vs Gastric Bypass vs Other Types of Bariatric Surgery
Lap band and gastric bypass surgery are by far 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 successfull long term outcomes.
The following pages provide comparisons and links to specifics for each procedure…
- Types of Bariatric Surgery – a high level overview and comparison
- Bariatric Surgery Complications Comparison
- Bariatric Vitamins - which vitamins and supplements you'll need after each surgery
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.
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For additional research, search for your topic...
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[Last editorial review/modification of this page: 1/24/2012]
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