A recent publication in the January 2012 edition of Archives of Surgery directly compared patients who underwent gastric bypass surgery with those who had gastric banding (either the Lapband or the Swedish band, known in the US as the Realize band). They concluded that both procedures were safe, and yielded good long-term weight loss after 6 years. They also stated that the weight loss following gastric bypass was superior to gastric banding. I would like to discuss these conclusions as they relate to actual weight loss, safety, and cost.
Long-term excess weight loss 6 years after surgery was reported as 78.5% for the bypass vs. 64.8% for gastric banding. While significant statistically, it is important to note that this amounts to only a 10-20 pound difference over the 6 year period. The question that patients and surgeons alike have to answer is, “What increased risk am I willing to accept for an additional 10-20 pounds?”
In this study, short-term complications were higher with the bypass, and long-term complications were higher with the gastric band. Of note, the Lapband device and surgical technique reported by the authors would be considered old technology today in the U.S. With the introduction of the Lapband AP System and better surgical techniques, the complication rates with the Lapband have decreased even further today. For instance, the band erosion rate reported in the 253 Swiss patients was 7.7%, while our erosion rate for over 4000 patients here at South Texas Surgeons is less than 0.5%. In addition, most Lapband complications can be readily handled in an elective, outpatient setting.
Cost is always an important consideration for patients looking into weight loss surgery. The Lapband is frequently performed as an outpatient procedure, with very little time lost from work. Although insurance premiums continue to increase for many Americans, benefits for weight loss surgery are frequently difficult to obtain or interpret. Even when benefits are available, high deductibles and other insurance requirements are significant roadblocks for surgery. We are very sensitive to this at South Texas Surgeons, and work hard to keep patient costs to a minimum. We do our best to work with all insurance plans, and offer the Lapband with an inclusive follow-up period for under $10,000 in order to make this life-changing procedure financially feasible for patients without insurance coverage.
In summary, the Lapband offers good long-term weight loss that closely compares to that of the gastric bypass. By increasing safety and decreasing costs (both direct costs and decreased time lost from work for recovery), the Lapband offers a compelling alternative to more invasive surgery.