lap band or bypass???

Hi everyone,

I'm very new to this but have my first appt coming up. I'm leaning towards lap band. Thoughts?

Some people are very successful with the lap band, but in general, the failure rate (as in failure to lose a significant amount of weight) and the additional surgery rate (to fix problems that arise after the band is placed (like a slipped band) or to remove the band entirely, with or without revision to another WLS) are alarmingly high.  I personally wouldn't even consider the band, but would encourage you to do some research on the outcome studies for the band.

The huge drawback of the gastric bypass (RNY, which is what I had) is a lifetime of fighting off nutritional deficiencies -- taking vitamins 3-4 times a day every day for the rest of your life and an extensive list of blood work that must be done at least yearly (and more frequently when you are trying to raise up a particular vitamin level) -- and increased risk of things like kidney stones, anemia, and reactive hypoglycemia.  Some people have very little trouble keeping their vitamin levels up while others have a lot of trouble.  Personally, if I was making the decision on which surgery to have now (sleeve was not available 7 years ago), I would probably opt for the sleeve (which doesn't have the nutritional issues of the RNY and doesn't have the complication rate and horrible outcome statistics of the band).  Does your insurance cover VSG?

The most important thing is to be sure that, whichever surgery you opt for,  you have done enough research, and have heard both the pros and cons of each surgery, and understand what you are signing up for.

Lora

I truly believe everyone should fight fiercely for a VSG or DS.  Lap bands are BAD NEWS.  I read the horror stories on line, but out of the handful of local bariatric patients I know, four of them got lap bands and only one has a good result.  Two have terrible problems, and one had her band removed.  That last one spent quite a bit of time in the hospital at her revision, because the band had adhered to her liver and she bled terribly after the surgery.  Fortunately, she is okay now with a revision to VSG.  My RNY has left me with deficiencies, hyperparathyroidism, and severe reactive hypoglycemia.  

I truly believe that patients should do their best to preserve their normal digestive tract.  For those who have a high BMI and issues that will mean just a reduction in stomach size won't come close to helping, I think the DS should be available.  Anyway, bands should be removed from the market, and someone should admit that too much faith has been placed in the RNY.

I find it interesting that despite the issues you have developed after RNY that you would advocate the DS which has even greater risk of nutritional deficiencies.  I understand that it doesn't carry the risk of RH, but it is not as if it is free from complications and/or undesirable side effects.

I did not like the idea of any kind of intestinal bypass, but since VSG wasn't an option 7 years ago, and my surgeon indicated that the chances of me losing 190 pounds with lap band were slim and none, I opted for RNY even though DS might have been more appropriate for me (starting BMI of almost 57) because of the lesser bypass.

Lora

I would only recommend a DS to someone (who has appropriately consulted with their physician) if they have a high BMI and their doctor doesn't think they'll achieve significant weight loss with a VSG.  As you can probably surmise, I would choose keeping my gastric channel intact for myself.  The DS does have great results for certain individuals.  My basic point is that the band sucks and RNY is not the 'gold standard' that most folks think it is.

I would only recommend a DS to someone (who has appropriately consulted with their physician) if they have a high BMI and their doctor doesn't think they'll achieve significant weight loss with a VSG.  As you can probably surmise, I would choose keeping my gastric channel intact for myself.  The DS does have great results for certain individuals.  My basic point is that the band sucks and RNY is not the 'gold standard' that most folks think it is.

How is RNY not the "gold standard," as you put it? It has a much longer track record than the sleeve, and many more procedures performed. Many develop complications with the sleeve, particularly acid reflux. Go to the revision board and see how many started with a sleeve and had it revised to RNY because of gerd or other issues.

There's no need to run down RNY.

Sorry, what is DS?

When you've had the complications I've had with RNY, you would run it down too.  That's all I'm saying on the matter.  

What does 'gold standard' even MEAN, when it comes to WLS? The 'gold standard' means a country holds enough gold to back their paper money. There's not enough gold in the world to back up a bad surgical result.

I'm NOT dissing your choice to have the RNY. The RNY has been successful for many years---they wouldn't still be doing it if it weren't. ALL forms of WLS currently performed (and some that aren't any more) have been successful for some people.

The Sleeve has only been around as a stand-alone WLS for about ten years---very true. BUT sleeve gastrectomies have been performed to treat ulcers, stomach cancer, etc. for over a CENTURY. The possible complications are VERY well known.

As for GERD---yes, the RNY is the go-to surgery for that. But it's not a sure cure, and many, many people find that their GERD is improved or cured with the Sleeve or the DS. (Mine was awful, pre-op. I slept sitting up most nights. After my DS---completely gone, for the past ten years.)
 

Grim,

I've done a lot of research on all of these surgeries, and the VSG has been around as a stand alone operation for about 10 years and IF surgeons believed it was better than RNY it would have taken over the "gold standard" status by now, but it has not.

Many people are having to revise from the Sleeve to RNY after a few years due to the high rate of long term horrible reflux that the Sleeve tends to create, so I am assuming horrible reflux is much more debilitating than occasional dumping syndrome which can be controlled with diet.

Sure RNY can come with its problems like hypoglycemia and hernias, nutritional deficiencies and other aliments (which can happen to Sleevers too), but they are treatable in most people whereas debilitating reflux and the problems it can cause can't be treated in most cases unless the patient revise to the Bypass.