Factors Influencing the Choice of Operation

The decision between having a lap band or a LGSRYB is made between the patient and the surgeon. The following table serves only as a rough guide and the decision needs to be made after careful consideration of all aspects for each individual. As there is relatively little long-term difference in terms of weight loss the less risky operation of a lap band is chosen more often.

  lap band lap gastric staple and bypass (LGSRYB)
Expected weight loss 60% of initial excess weight at 1 year 75% of initial weight loss at 1 year
Rate of weight loss Gradual and may take some patients 2 years before weight loss stops Rapid weight loss in first 3 - 6 months after surgery with a plateau between 12 and 18 months after surgery
Can I regain weight? Yes, if non-compliant with healthy eating and lifestyle commitment. Tightening of the band can help stop weight gain. Yes, if non-compliant with healthy eating and lifestyle commitment.
Length of operation 40 - 70 minutes 1.5 - 3 hours
Length of hospital stay 1 night 2 - 4 nights
Period of convalescence 1 week to 10 days 2 - 3 weeks
Risk of death after surgery 1 in 1000
increased when age > 50,
BMI > 50 and known heart disease present 		1 in 200
increased when age > 50
BMI > 50 and known heart disease present
Complications - short term Bleeding - internal <1%
Port site infection <1%
Tight band 2% 		Bleeding internal 2% Gastrointestinal leak 3%
Heart attack < 1%
Pulmonary embolus <1%
Port site infection 1.5%
Re-operation 4%
Complications - Long term
 Band slippage 1%
Band erosion 1%
Band leak/unbuckling 1%
Tubing disconnection / break 2%
Failure to lose weight or reach desired weight 10 - 30%
Need for additional surgery 5% 		Narrowing of pouch exit 4%
Stomach pouch ulcer 1%
Port site hernia 1.5%
Fistula to stomach 0.5%
Small bowel obstruction / hernia 1%
Need for additional surgery 2%
Diet-lifestyle changes required Avoid snacking on high sugar foods, commitment to healthy eating. Certain foods can get stuck on the band (rice bread, dense meats, nuts). Must add exercise to daily routine e.g. 3 miles walking / day. Commitment to attend for follow-up and band adjustments. Avoid snacking on high sugar and fat foods to avoid dumping syndrome and diarrhoea. Supplements are always required to prevent mineral and vitamin deficiency. Must add exercise to daily routine e.g. 3 miles walking / day.
Lifelong nutritional supplements required Not usually, though multivitamin during period of weight loss may help. Multivitamin
B12 (injections sometimes required)
Calcium
Iron
Is operation reversible? Tightness of band can be adjusted and in effect lead to reversal of the operation. Band can be removed though weight gain is then usual. Very major surgery required to reverse this procedure. Best considered totally irreversible.
Our recommendation Best for patients with a BMI between 35 and 55 who see this as part of a process which requires some personal commitment to change lifestyle.
Best when portion control is a major issue and when chocolate and other sweets can be controlled. Not to be seen as a quick fix. 		Best for patients with a BMI over 50 who have an uncontrollable sweet tooth and are unable to engage in a meaningful exercise programme.
Not suitable when risk is high due to presence of complications of associated illness e.g. previous heart attack.
Final note If you are at a point in your life that you see the need for weight loss as well as the need to change your lifestyle this may be the correct choice for you. A commitment to return for band adjustments and regular follow-up is required. Sometimes viewed as the higher risk but easier option from the viewpoint of personal commitment. However, failure can still occur and longer-term follow-up of metabolic consequences is required.

What factors are associated with poor weight loss after surgery?

The following factors are associated with poor weight loss after any form of surgery, but particularly after the lap band.

  • Initial BMI > 50
  • Age > 50 years
  • Inability or unwillingness to commit to trying to avoid chocolate, ice cream, crisps, sweets and other high sugar foods.
  • Inability or unwillingness to commit to changing activity and exercise levels.

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