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The Differences in the Gastric Sleeve, Gastric Bypass, and the LAP-BAND and Which One Is Right for You

By Caitlin Hastings, Physician Assistant

Patients often come to Birmingham Minimally Invasive Surgery wanting the least invasive surgery possible, and while this is completely understandable, the fact is, all of our weight loss surgery options are, well, minimally invasive. With the gastric sleeve, gastric bypass, and the LAP-BAND being the most common of the weight loss procedures, each is done laparoscopically, requiring only 4-6 tiny incisions and less than 2 hours in the operating room.

Another factor that patients often overlook is how insurance plays a major role in choosing which weight loss procedure is best for them. While many insurance companies require a certain BMI for different surgeries, this can often dictate which ones are covered. On the other hand, for those paying out of pocket, the cost of the procedure often plays a major role. Take a closer look at the most common weight loss surgeries below to get a better understanding of which one might be right for you.

The Gastric Sleeve Procedure

During gastric sleeve surgery, we’re basically cutting away the top and largest part of the stomach called the fundus. This is where the hunger hormone, ghrelin, lives, and that’s why we often hear our post-surgery patients say they’re never hungry. Along with eliminating this hunger hormone, we’re also removing about 2/3 of the stomach, which is why these two combining factors lead to significant weight loss.

 

Who’s a good candidate for gastric sleeve?

Those using insurance to cover the procedure must have a minimum BMI of 35 to 40, along with various comorbidities like diabetes, sleep apnea, or heart disease or a BMI > 40 with or without comorbidities. While the sleeve is great for anyone that meets these requirements, patients that have severe acid reflux disease aren’t going to be good candidates since this procedure has shown to be acid inducing.

What are the benefits of the sleeve as opposed to other weight loss surgeries?

Compared to other weight loss surgery options, the sleeve is definitely a simpler procedure. We’re not rerouting the intestines like we do during the gastric bypass, and we’re not putting in a foreign body like we do with the LAP-BAND. It’s a quick procedure where we’re literally stapling the stomach and cutting 2/3 of it away, leaving the patient with a very small banana-sized stomach.

Gastric Bypass Procedure

With the Roux-en-Y gastric bypass, we create a very small stomach pouch that restricts food intake. Next, a Y-shaped section of the small intestine is attached to the pouch that allows food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).This ultimately reduces the amount of food you can take in because you have a very small stomach that holds about one to two ounces. At the same time, we’re decreasing the absorption of food and nutrients, which also aids in the weight loss.

 

Who’s a good candidate for gastric bypass?

The bypass is usually a better option for our heavier patients because most will lose up to 80% of their excess body weight as opposed to about 60% with the sleeve. It’s also going to be the better option for anyone with severe acid reflux or poorly controlled diabetes since the bypass has proven to cure both.

What are the advantages and disadvantages of gastric bypass?

The gastric bypass is technically considered reversible, but we never want to reverse this procedure because you will gain all of your weight back. After surgery, you do have to be on nutritional and vitamin supplements for life because of the malabsorption of food. For patients with more weight to lose and more comorbidities, like sleep apnea, high blood pressure and/or diabetes, gastric bypass really is going to be a better procedure overall with more rapid weight loss.  

A lot of people are afraid of the bypass because they think it’s a much more “invasive” procedure, but it’s really not. It’s about the same amount of incisions, 6 versus 5, and it’s still done completely laparoscopically. It’s just a little more labor intensive because we’re changing the anatomy.  

The LAP-BAND Procedure

During this procedure, we place the LAP-BAND, a foreign body made of a special material, near the top of the of the stomach where it meets the esophagus. This creates a very small pouch that empties into the larger remaining portion of the stomach. The band is connected to a port, which is underneath the skin of the abdomen, and this port how we put fluid in the band, allowing us to make the band opening larger or smaller in size, giving the patient more or less restriction.

 

Why choose the LAP-BAND?

Many patients prefer the LAP-BAND because they don’t want anything permanent done, and with the LAP-BAND were not changing the anatomy of the stomach…so it’s completely reversible. We can always go in and take the LAP-BAND out if the patient chooses to do so.

Another reason patients prefer the LAP-BAND, especially those paying out of pocket, is because it’s about $2,000 less than a sleeve…so it’s one of our more cost effective procedures.

What are the advantages and disadvantages of the LAP-BAND?

The LAP-BAND isn’t necessarily an overnight fix. We have to find that “happy place” where the patient is able to get food down but also able to maintain smaller portion sizes, and that’s where these band adjustments come into play.

The goal of all of these procedures is for the patient to lose weight, but it’s still important to keep in mind that none of them are a magic fix for permanent weight loss. While it will certainly help, diet and exercise are still going to be important. Eating the right foods, not consuming excess calories, and establishing an exercise routine are essential when you’re trying to lose weight and keep it off.  No matter which weight loss surgery a patient ends up going with, it’s important that they have the right mindset and are ready to make major lifestyle changes.

Birmingham Minimally Invasive Surgery is a caring group of professionals who specialize in all types of bariatric surgery.  Our surgeon Dr. Jay Long has highly specialized training in bariatric surgery, having completed a fellowship in minimally invasive and bariatric surgery at The Methodist Hospital in Houston, Texas, where he focused on taking care of patients that are morbidly obese.  And we are so proud of our pricing that we publish the costs right on the front page of our website!  Insurance won’t pay?  We have a variety of financing options we can offer you so that you are able to get the healthy body you’ve wanted for years.  Visit us today at http://www.bmisurgery.com/ or give us a call to set up a consultation at 205-833-6907.