Backstage Pass, Part 3...

                                                                                                   Photo by M Clock

OK, so what's the catch?

What's the catch for a shorter operation time, outpatient procedure, quicker return to work, and no transection of the stomach or intestinal interposition?

Less complications!  I guess that's not really a catch, but it is something to think about, and it holds up over time vs. Bypass and Sleeve, reported as "3x less than Sleeve Gastrectomy and 4x greater than Gastric Bypass" on the Lapband site.

Those would be the complications of bleeding, staple line leak, and port site infection early; and port site hernia, stricture, marginal ulcer, bowel obstruction and nutritional deficiencies, which may occur later.

So, what's the catch?  Still haven't answered the question, have I?  Maybe I should go into car sales- the best answer is another question... Using my insight and experience, as well as Risk Information from the Lapband site let's clarify:

1. There are the practical issues of slower weight loss -generally 1-2 lbs a week if all goes well.  Not really a 'complication', but a side effect, and one that the patient may forget from time to time even when they are doing well with the Band.

2. Temporary "over-restriction"  which is a relative over-tightening of the band, either by too much fluid given at an adjustment, or a patient eating in a non Band-friendly fashion (too fast, too much, too dry, too coarse of a texture).  Usually treated quite easily by removing a small amount of fluid, with dietary re-education as needed.

3. Mechanical failures of port malfunction (usually leaking, although rare), band leakage (never seen it, but reported), and detached or poorly positioned access port which may cause pain and may need reattaching to the abdomina wall.  Occasionally a port is very difficult to access, and may need X Ray / fluoro to access.

4. A "slip" (11%) is another way to describe a gastric prolapse that may occur over time, usually as a result of recurring vomiting, as a result from, again, over-tightening of the Band and/or behavioral influences.  It can run the spectrum of asymptomatic to the severe pain of impending gastric infarction if not recognized early.  A re-operation may be needed if the patient does not respond to the conservative, but very often successful, removal of fluid to let the band / stomach pouch rest.

5. An erosion of the Band (1%) can occur due to the foreign body effect of the Band over time, certainly encouraged by smoking and NSAID usage.

6. The more nuisance side effect of GERD (34%), is usually remediated by taking some fluid out of the Band, or coaching the patient again on proper eating habits.

Yikes, sounds worse than it really seems to be in every day practice.  We have done well over 500 Bands in our practice, and although there is an occasional difficulty with the Band patient and "side effects", most Band patients love their Band and come to enjoy it's automatic portion control and hunger suppression as they lose their weight.

In our experience however, the Band seems to be the procedure that's easiest to beat.  It relies the most on proper behavior and frequent follow up to achieve significant and lasting weight loss, and likely has the lowest weight loss of the 3 procedures, net, in comparison.  That being said, in some studies, such as the Swedish Obesity Study the Band held it's own over the 15 year study time period.

To summarize - you get what you pay for.

Avoiding some possible complications of a likely more effective procedure, for a simpler technical procedure that has the higher potential to be suboptimal in its effect is a patient's choice.  Often a Band patient will either have a Band or no weight loss surgery at all. We inform all of our patients the risks and benefits of all the procedures we offer (Band /Bypass/Sleeve) during their 2 preoperative visits with the surgeon, and generally let them decide which is best for them.  Having a patient "buy in" to how the surgical tool of their choice will work is a huge part of the process, is reviewed and reinforced preoperatively by our Registered Dietitian, and is linked directly with weight loss success.

In final summary, all information aside, all 3 of these tools are safe and effective, significantly more effective than non-surgical weight loss, and very likely markedly safer than no weight loss at all.  The choice is up to the patient, and up to you to be informed and have a good idea of potential candidates that would benefit form weight loss surgery, whether it be Band, Bypass, or Sleeve.

Sometimes, even in Obesity, To Cut Is To Cure.