Gastric band v gastric bypass - your thoughts

Whatever you decide your friends on MFP will support you!

amen.

I'm baaaaaack....The continuous voice on the weight loss surgery boards.....
As I always say, DO NOT LISTEN TO THE OPINION OF ANYONE who has not ACTUALLY had the surgery, because SO MANY people have no idea what they are talking about. There is so much involved in making this decision, as you probably know by now, yourself. Whether it's "wrong" or "not necessary" or "cheating" or "the easy way" or "dangerous"........all of these responses are from the uninformed as to why people get the surgery and how it works and the modern statistics with the many new methods being used for surgery.

With that said. I have had a lap band for 10 months, however, the first three months, I could not have any fluid in the band due to a large hernia repair that was performed at the same time the band was installed AND I had the fluid removed for three months due to a mastoidectomy operation. When you have a lapband, you must deflate the band for any form of intubation. When the band is deflated, it does not prevent hunger, which is a huge function of the band. So, technically, I have had a functioning band (through no fault of the band surgery, itself) for about 4 months and have lost 52 pounds.

The best source of information on which method to choose somes from your doctor, because he/she knows your history, you Achilles Heel as far as eating is concerned, etc. BUT, if you are offered both equally, here are some FACTS....

1. The lapband is a simpler surgery for the doctor, but more work for you. It can be adjusted at any time or removed. The ports have been updated. The operation is done laproscopically and you are in the hospital overnight and home the next morning if all goes normally. Some people have one fill and they are properly adjusted, others can take several months. I know of NO ONE taking a year to get the band to the right filling, but maybe I'm lucky to have a wonderful doctor who does close to 3,000 surgeries every year and has been performing the operation for 10 years.
2. The lapband is placed where your esophagus meets your stomach and is tightened to keep the food in a location where it stimulates the nerves that tell your brain that you are full, so you learn to get back in touch with real hunger and emotional/mental hunger. Your stomach, itself, it not touched and your digestive system is untouched. This restriction means that you have to eat slowly, chew your foods thoroughly and learn which foods will gum up and get "stuck" and unable to pass through the restricted opening, which causes you to, perhaps, vomit to dislodge the food. Each person has a different set of foods that gets stuck. Generally, white bread, rice, potatoes, dry meats, etc. are the main offenders. IF you eat liquid calories: milkshakes, mashed potatoes, sugared sodas, puddings, soups, fruit juice, ice cream, etc., the band will not help you because these types of foods slide right past the band without sending the "full" message to your brain. If you cannot control these types of food, then bypass is a better choice. If you are a carb craver, this is a good choice for you. The band will help you control your portions.
3. Complications: Band slippage, band erosion......which would require a surgery (about 45 minutes, like the original surgery) to reposition or replace the band. If you do not intend to make healthy food choices, walk at least 15-20 minutes a day, and log your food, attend support group meetings and read your food labels, do not get EITHER surgeries. Many people do not lose all of the weight to reach their perfect goal, but they lose enough to be healthy again. Some people look at it as if it is a diet, and once they hit a certain point, they no longer practice the program and gain back the weight.
4. Lapband....NO HAIRLOSS (unless you do not eat protein), NO MALABSORPTION (unless you do not eat a healthy balance, and a multi-vitamin), death rate on the surgery pre or post surgery is NOT considered "risky"......that is bunk.
5. Bypass....you will lose weight faster because the doctor is doing most of the initial work with the surgery, but you have to realize that you STILL need to learn the guidelines because you will eventually need your willpower again. Your pouch CAN stretch. You CAN get "dumping syndrome" which is throwing up when certain foods don't agree with you. This is different from the band. With the band, you are throwing up to dislodge food, not because you are sick to your stomach. With the bypass, some people are more sensitive than others. I know many people who don't have food sensitivities, but those people are VERY careful about what they put in their mouths. Longer recovery time, but that is because it is a more complicated surgery.
6. Bypass....by reducing the size of your stomach to the size of a fist or a large egg and then rerouting your digestive system, you can only take in a small amount of food in order to feel full. It works very fast and very well during the first 18 months or more. After that, if you have NOT pushed your portions, it will remain small. Now, since I have a band and not a bypass, I can't tell you how it feels after 18 months, but in my support group, I have heard a wide variety of responses. Many people make it a new set of habits, others still face a day to day struggle with their food addictions. Many people keep the weight off and some people gain it back...some or all. Some weight loss patients transfer their addictions to other types of addictive behavior, like shoplifting, alchohol, etc., but it is a small percentage.
7. Many of the horror stories happened during a time when the bypass was NOT being done laproscopically, meaning it was an open operations which risked a higher rate of infection. Now, there IS still a risk due to anesthesia, infection and pouch leakage. But, most doctors who have earned the rating of Bariatric Center of Excellence, use pouch leakage testing right after surgery to ensure that the pouch is properly sealed.

The main reason most people fail with weight loss surgery is that they have NOT been honest with themselves prior to surgery. They expect the surgery to do it all, or figure that once they lose the weight, they can have the pizza and cake and the hidden stash of chocolate. This is a TOOL. It is not without effort and sacrifice. It is not 100% without risk, but most people who choose these surgeries have a BMI of 40 or more and have additional health risks that, STATISTICALLY, pose a higher risk than that of the surgery.

The bypass will require you take vitamins and eat enough protein. Same with the band, but there are more side effects if you don't do so with the bypass.

If you do NOT have a BMI of 40 (35 with 2 or more co-morbidities) or are 100 pounds overweight for your height.....if you have not yo yo dieted...if you haven't seriously tried dieting, then surgery if pre-mature for you.

Falacies:
1. Everyone can lose weight the same way...psychologically. Just set your mind to it. OK, well, if you've lost that same 100 pounds 2 or 3 times over and over......chances are, you can use the help of wls.
2. WLS has a high rate of mortality.....False....I don't have the most recent stats, but bands have a very small rate and when bypasses were being done open, I believe the rate was 1% or .5%, much lower than the risks or obesity.
3. It's a "drastic" measure. The band is a 45 minute operation and both surgeries require extensive testing and evaluation prior to surgery. It will not be performed unless the doctors, psychologists and other specialists feel that a patient will be successful.
4. It's a "bad idea"......that should be left up to the doctors.

If you don't have as much weight to lose and just need a bit of help, I would choose the band because you will have to do more work yourself, which means your weight will be slower and you are more likely to make permanent habit changes. But, ask your surgeon his opinion on both of them and the pros and cons for your unique situation.

Email me if you have specific questions. And, see if you can find someone with a bypass to give you more indepth info from a personal perspective. Ask that person if they still go to support groups, if they plan their meals and make sure that they ARE following the program. If not, and they complain. It's them and not the surgery that is probably the problem. In our practice, we have lifetime nutrition support and are encouraged to make regular appointments (no charge) with the staff of nutritionists after surgery. We can attend as many as 9 support groups per month at different days and times and locations.

Good luck on your decision about whether to have surgery and, if so, which surgery you choose. (By the way, there are many support group topics on dealing with the WLS trolls and jealous friends, non-supportive friends, people who want you to fail, are misinformed about surgery, etc.....you should be sure to attend ALL of these because many people who are uninformed, think that because they have a friend or co-worker or even a few of them, makes them "informed", and do not realize that there is much more than hearsay to being truly "informed" and "educated" on wls.)

I've been to Vegas plenty of times and one thing i do know is that the house typically wins.......

so be honest, is this really something you are doing to be healthier overall, (considering all the possible negative complications) or for vanity?

Wow, is this a non-sequitur! "The House" in Vegas has NOTHING to compare to a medical procedure that has two decades of successful history. Vanity? Then all weight loss must be vanity? I am so sorry, but if anyone is tempted to accept this post as any factual or helpful information, please reconsider. While I respect others' rights to voice an opinion, but it has to at least be comparing apples to other fruits. This is compaing games of chance to a tested medical procedure. :noway:

The bypass will require you take vitamins and eat enough protein. Same with the band, but there are more side effects if you don't do so with the bypass.

If you do NOT have a BMI of 40 (35 with 2 or more co-morbidities) or are 100 pounds overweight for your height.....if you have not yo yo dieted...if you haven't seriously tried dieting, then surgery if pre-mature for you.

Gerawt Post -- just 2 comments:

1. If you have co-morbidities like diabetes, you can get approved with a bmi of 35 and be less than 100 lbs overweight. AND surgery still covers it.

2. This is the perfect time to change your goals here to include higher protein, lower carbs .. I still love protein shakes and 3 years out it would still be hard to eat 100g of protein a day for me, so I drink it.

NOT THE END ALL TO BE ALL: A dear loved one had gastric bypass surgery about 6-7 years ago. Prior to that, she tried every diet imaginable, had a gastric balloon put in in the 80s; you name it, she tried it. Pre-gastric bypass, she weighed about 350 lbs. Post-bypass, she slimmed down to a size 9. She has additional surgery to remove all the excess skin from her arms, legs, and belly. She stayed a size 9 for about 2 years. Slowly and surely the weight started creeping back. Today, she is probably 250 lbs. She was turned down for a gastric bypass re-do and the lap band. She is now on Weight Watchers. Conversely, I met someone who regretted having gastric bypass because she is now 90 lbs., throws up every day, and struggles to keep at her present weight.

My Uncle got the bypass a few months ago. His reasoning was that with the bypass there is no going back but the gastric band can always be taken off.
I saw him for the first time since the surgery last week and he looked so good and seems so much happier.

The LAP-BAND is a _tool_ to aid in your weight loss; it's not a cure-all. The bypass will help you lose weight quicker, but you will also plateau quicker (and also run the risk of gaining it back, especially if you drink...my former roommate's sister is a good example of this. She had the bypass, lost a lot of weight, but was too fond of alcohol and gained it all back...and then some).

I'm on the neither camp for this reason, particularly in reference to the OP.

To the OP: you stated that they usually fall off the wagon after a couple of days of dieting. If you really are only able to hold on to healthy eating for a couple of days at a time then no surgery is going to fix those bad eating habits. That is something you'll need to address. If you were to get a band - and in time get it loosened - could you honestly say that you wouldn't immediately overindulge?

I don't condemn anyone for having these types of surgeries but I would always leave it as a last resort. I'm not entirely convinced you've really given your all to losing weight the natural way and my worry is that you'll end up doing more harm than good to your body.

Even with surgery you will need to change the habits that have made you and keep you fat. It's not a magic spell that will make you and keep you thin - you will have to eat moderately, exercise ---- the SAME things that if you do on your own will make you thin.

227 is what I weigh now. I can't imagine considering surgery at my weight. Support, information, determination - those are the tools you need to get control of your weight.

I have to say, I would not do either. I started my journey over two years ago and today stepped on the scale and found "wonder land" ...199! I have lost 91 pounds total. I have used MFP but when I became frustrated I did seek assistance from a local weight loss clinic that my insurance covered! I love my Doctor. He has helped me get where I am today. I have at time taken meds...phentermine...and am happy to report that did not gain when I was off them...rather continued to loose just at a slower rate. Find an exercise that you enjoy. I fell into kick boxing and love it! I feel like surgery is such a drastic option. What ever your decision...Good Luck !