About Gastric Bypass Surgery

Like Lap Band surgery, gastric bypass is a type of weight-loss surgery used to treat patients who are excessively over weight. Gastric bypass was introduced more than 35 years ago. About half of gastric bypass operations are performed through open surgery, which requires a long incision to the abdomen. The other half is performed laparoscopically.

Gastric bypass involves a stapling device that cuts and separates a small piece of the stomach (known as the "pouch") from the rest of the stomach. The pouch becomes the new stomach and the rest is closed off permanently. Depending on the procedure, the pouch is then connected either to the middle portion of the small intestine (jejunum), "bypassing" the upper portion (duodenum), or further down at the distal ileum. In this way, the newly-created, smaller stomach can pass food further downstream so that the digestive juices from the liver, gallbladder, and pancreas are included in the digestion process. In a final step, the surgeon sometimes connects the jejunum to the duodenum so that its digestive juices can contribute as well.

By bypassing sections of the stomach and small intestine, gastric bypass surgery has the effect of reducing hunger, as well as absorption of nutrients and calories. This combination of effects contributes to the weight-loss that occurs after surgery.

Two Procedures: Roux-en-Y and Biliopancreatic Diversion

There are two main versions of gastric bypass surgery: Roux-en-Y and Biliopancreatic Diversion. Rou-en-Y gastric bypass surgery comes in two forms: the traditional procedure, which is performed via a long incision in the abdomen, and laparoscopic, which uses a camera (laparoscope) so that smaller incisions can be made. In Rou-en-Y gastric bypass surgery, the newly-formed pouch is connected to the middle of the small intestine (jejunum), which allows more nutrients and calories to be absorbed. In contrast, the Biliopancreatic Diversion procedure attaches the pouch to a section of intestine that is located further down, thereby severely restricting absorption of nutrients and calories. Biliopancreatic Diversion is a very complicated procedure that can lead to serious complications in some cases. As result, this procedure is rarely used in the U.S.

Potential Complications of Gastric Bypass Surgery

Gastric bypass is a major surgical procedure with a risk of serious complications or even death (mortality rate: approximately 1%). It causes significant changes in the digestive tract and is fundamentally irreversible.

Gastric Bypass Recovery

After surgery, most patients remain in the hospital for one to three days, depending on outcome and the procedure performed. Several weeks of additional, at-home recovery are also necessary. Because gastric bypass surgery causes abdominal swelling, most patients feel very sore in the initial days following the procedure. Gastric bypass surgery also leaves a scar. Most surgeons who perform gastric bypass surgery give their patients a dietary plan. Patients are instructed to exercise consistently.

Gastric Bypass Surgery vs. The Lap Band Procedure

Early studies from Europe showed Lap Band procedure patients experienced less significant weight-loss results than gastric bypass patients. However, more recent studies (including those by Dr. Paul O'Brien, M.D.) have published results showing that Lap Band procedure patients experienced weight-loss that actually exceeded amounts lost by gastric bypass patients after a period of five years.

Procedure Differences

The Lap Band System requires no cutting, stapling, or removal of any part of your existing stomach, nor any intestinal rerouting.¹⁵

With Gastric Bypass, cutting and stapling of stomach and bowel as well as rerouting of the intestine is required.¹⁵

Adjustability

Lap Band can be quickly, easily, and non-surgically adjusted to affect weight-loss results²³ — during a brief doctor’s office visit.

To make any “adjustments” or to improve weight-loss results from Gastric Bypass, additional surgery may be necessary.

Reversibility

The Lap Band System is reversible and, if necessary, can be removed — with the stomach usually returning to its original shape.

Gastric Bypass is extremely difficult to reverse, requiring additional, complicated surgery — without guarantee of success.

Safety

Long-term results (three to five years) with the Lap Band System yield comparable results to the gastric bypass — without the associated risks of the more invasive bypass procedure.²

May offer more rapid initial weight-loss but some patients with gastric bypass will regain some weight over time.²⁴

After about three years, weight-loss with Gastric Bypass is comparable to the Lap Band System.²

Results & Risks

As stomach cutting, removal and stapling are involved, gastric bypass surgery can have more operative complications.²⁰

A less invasive operative procedure, the Lap Band procedure has a lower rate of operative complications than gastric bypass.²⁰

As the Gastric Bypass procedure “bypasses” a portion of your intestine, it may increase the risk for anemia, osteoporosis and other medical complications due to nutritional and vitamin deficiencies.^{24, 25}

Since none of the intestine is removed or bypassed with the Lap Band procedure, there are low risks of problems absorbing necessary nutrients.^{25, 26}

With the Lap Band procedure, you will not lose as much lean muscle mass and bone mass as you would with gastric bypass — that means you maintain more of the lean muscle mass you need to keep your metabolism working effectively.^{27, 28}

With Gastric bypass, there is a risk of “Dumping Syndrome” — a condition that may occur when food is rapidly passed (dumped) from stomach to upper intestine. Symptoms may include cramps, nausea, speeding or slowing of the heart, etc.²

There is no risk of “Dumping Syndrome” with the Lap Band procedure, since no part of the intestinal tract is bypassed.²

Lap Band:

• Mortality rate: 0.05%¹⁹
• Total complications: 9%²⁰
• Major complications: 0.2%²⁰

Most common complications include:

• Standard risks associated with major surgery
• Nausea and vomiting²¹
• Lap Band System slippage
• Stoma obstruction

The risk of death following surgery is 10 times less compared to gastric bypass.²⁹

Bypass:

• Mortality rate: 0.5%¹⁹
• Total complications: 23%²⁰
• Major complications: 2%²⁰

Most common complications include:

• Standard risks associated with major surgery
• Nausea and vomiting¹⁵
• Separation of stapled areas²¹ (major revisional surgery)
• Leaks from staple lines (major revisional surgery)²⁰
• Nutritional

Gastric bypass has a higher risk of death following surgery compared to Lap Band.²⁹

References:

¹Directions For Use (DFU). LAP-BAND AP^® Adjustable Gastric Banding System with OMNIFORM^® Design. Allergan, Inc. Irvine, CA. 08/09. The LAP BAND System was approved in the United States on the basis of a nonrandomized, single-arm study (N=299). Significant improvement in percent of excess weight-loss vs. baseline was achieved at 12 months (34.5%), 24 months (37.8%), and 36 months (36.2%).

²O’Brien PE, et al. Systematic review of medium-term weight-loss after bariatric operations. Obes Surg. 2006;16(8):1032-1040.

³American Association of Clinical Endocrinologists/American College of Endocrinology Obesity Task Force. AACE/ACE Position Statement on the Prevention, Diagnosis, and Treatment of Obesity (1998 Revision). Endocr Pract. 1998;4:297-350.

⁴Dixon JB, O’Brien PE, Gastroesophageal reflux in obesity: the effect of Lap-Band placement. Obes Surg. 1999;9:527-531.

⁵Dixon JB, Chapman L, O’Brien P. Marked improvement in asthma after Lap Band surgery for morbid obesity. Obes Surg. 1999;9:385-389.

⁶Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25:358-363.

⁷Dixon JB, Schachter LM, O’Brien PE. Sleep disturbance and obesity. Arch Intern Med. 2001;161:102-106.

⁸A Surgical Aid in the Treatment of Morbid Obesity, LAP BAND System Information for Patients (P/N 94829). Allergan, Inc. Irvine, CA. April, 2008.

⁹Weiner R, Blanco-Engert R, Weiner S, et al. Outcome after laparoscopic adjustable gastric banding – 8 years experience. Obes Surg. 2003;13:427-434.

¹⁰Data on File. Allergan, Inc. Irvine, CA. November, 2009.

¹¹FDA approves REALIZE™ adjustable gastric band for morbid obesity. Ethicon Endo-Surgery, Ind., press release. Available at: http://www.ethiconendo.com/dtcf/pages/press_room_4.htm. Accessed on September 23, 2008.

¹²Mittermair RP, Weiss HG, et al. Band Leakage after Laparoscopical Adjustable Gastric Banding. Obes Surg. 2003; 13:913-917.

¹³Reijnen M, Naus JH, et al. Mechanical Evaluation of a Ruptured Swedish Adjustable Gastric Band. Obes Surg. 2004;14:253-255.

¹⁴Piorkowski JR, Ellner SJ, Mavanur AA, Barba CA, Preventing port site inversion in laparoscopic adjustable gastric banding, Surg Obes Relat Dis. 2007 Mar-Apr;3(2):159-61; discussion 161-162.

¹⁵Weight-control Information Network (WIN), an information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gastrointestinal Surgery for Severe Obesity. December 2004. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Accessed May 2, 2007.

¹⁶Data on File. Allergan, Inc. Irvine, CA. April, 2009.

¹⁷Weiner RA, et al. Laparoscopic Sleeve Gastrectomy – Influence of Sleeve Size and Resected Gastric Volume. Obes Surg. 2007;17(10):1297-1305.

¹⁸Lalor PF, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33-38.

¹⁹Chapman A, et al. Systematic review of laparoscopic adjustable gastric banding for the treatment of obesity: update and re-appraisal. Executive summary. ASERNIP-S Report No. 31. Second edition. Adelaide, South Australia: ASERNIP-S, June 2002.

²⁰Parikh MS, et al. Objective Comparison of Complications Resulting from Laparoscopic Bariatric Procedures. J Am Coll Surg. 2006; 202:252-261.

²¹Clegg AJ, et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6:1-153.

²²Aggarwal S, et al. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189-194.

²³Fakhro, J. Comparison between laparoscopic gastric banding and laparoscopic sleeve gastrectomy. World Journal of Laparoscopic Surg. 2008; 1(2): 29-31.

²⁴Faria SL, Kelly E, Faria OP. Energy Expenditure and Weight Regain in Patients Submitted to Roux-en-Y Gastric Bypass. Obes Surg. Apr 28 2009.

²⁵Bernert CP, et al. Nutritional Deficiency after Gastric Bypass: Diagnosis, Prevention and Treatment. Diabetes & Metab. 2007; 33:13-24.

²⁶Vilarrasa, N. Evaluation of bone disease in morbidly obese women after gastric bypass and risk factors implicated in bone loss. Obes Surg. 2009; 19: 860-866.

²⁷Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight-loss: a systematic review. Int J Obes (Lond). May 2007;31(5):743-50.

²⁸Dixon JB, O’Brien PE. Nutritional Outcomes of Bariatric Surgery. In: Buchwald H, Cowan GSM, Pories WJ, eds. Surgical Management of Obesity. Philadelphia, PA: Saunders Elsevier; 2007:357-364.

²⁹O’Brien PE, et al. LAP BAND: Outcomes and Results. J Laparoendosc Adv Surg Tech A. 2003; 13(4):265-270.