Gastric Bypass vs. Lap ban Surgery - Report Example

Gastric Bypass vs. Lap ban Surgery Research Paper Introduction Bariatric surgery is a broad term; it includes almost all those surgical procedures that are used to curb obesity i.e. to cause weight loss. According to the United States ‘National Health Institute, bariatric procedures are only prescribed for obese people with body mass index (BMI) of 40 or more. However, in certain cases people with BMI of 35 are also asked to undergo bariatric procedures due some maladies caused endocrinal imbalance or diabetes (Tice, Karliner, Walsh, Petersen, & Feldman, 2008). There are several types of bariatric surgical procedures, they include Endoluminal sleeve, Roux-en-Y gastric bypass, Jejunoileal bypass, Vertical banded gastrplasty, and Adjustable gastric band. In the following text the discussion will be focused on the comparison between the Roux-en-Y gastric bypass and Lap Band Surgery. Procedure Roux-en-Y gastric bypass is an extremely invasive process. The stomach is divided into two parts (the food remains in the gastric pouch which is smaller in volume); and each part is connected with small intestine by stapling. A Y-shaped division of small intestine is produced; the two ends of the Y-shaped small intestine are called proximal limb and distal limb. The proximal limb is also known as Roux limb, which is produce by using 35-51 cm of the small intestine. The use of intestine for creating bypass route for food reduces body’s capacity of absorption, plus alteration in the anatomy may also affect the endocrinal activities of the alimentary canal. The use of Lap band is the second most common bariatric surgeries. It is commonly preferred over other procedures because it is least invasive, it is reversible, and it does not alter any endocrinal activity. The process is relatively simple. It includes the division of stomach into two pouches; the pouches are produced by wrapping and tightening of silicon band around the stomach. There is no discontinuity between the two pouches except for the bend that is generated by the silicon band. The silicon band used in this procedure can be varied in its size by injection or removal of saline solution. Efficiency The average loss of weight in case of lap band adjustment is up to 50 percent; however, in certain cases it may get restricted to fewer than 25 percent, or exceed 80 percent. This suggests that the results are very variable in this procedure. The reason for this variation may be on the basis of default stomach size, the quality of band, the adjustment follow up, diet and exercise. Less variance is observed in mean average weight loss of patients who undertake Roux-en-Y Bypass surgery (Tice, Karliner, Walsh, Petersen, & Feldman, 2008). The average weight loss as a result of bypass is 60-65 percent. Most of the weight is lost in first six to nine months after Gastric bypass surgery; this post operational phase is also known as the “honeymoon period”. On the other hand weight loss in case of patients with lap bands occur gradually with time, general after several adjustments. In the longer run Roux-en-Y surgery has a success rate of almost 90 percent, while the success rate of lap band adjustment procedures is 60 to 85 percent. It is also reported that bypass has a very high efficiency as compared to the adjustment; a study suggests that 28% more weight loss is observed in patients with bypass surgery (Nguyen, et al., 2013). The lack of efficiency of weight loss in case of adjustment bands is due to inadequate loss, improper adjustment, and complications that require removal of the band (Fisher, 2004). Another reason behind the success of bypass procedure is that it reduces the production of ghrelin which is a hunger inducing hormone, so the patient gets less hungry, while no such change occurs by the introduction of lap bands. As there is an alteration in the endocrinal activity of the body, patients who have got bypass may find a bit variation in the taste of goods, while no such changes are observed after lap band adjustment (Nguyen, et al., 2013). Risks All the bariatric surgeries have more or less some risk attached to the procedures. Some of these risks are prevalent in almost all the procedures, while others are specific to protocol. Some of the common conditions that may result from weight loss surgeries are deep vein thrombosis, infection on the sites of incision, sepsis, pulmonary embolism, anemia and peritonitis. Even though Lap band adjustment is considered the safest of all the bariatric surgeries, however it does have some risks associated with it. The most of common risk of this procedure is that it may result in obstruction of food’s movement from upper to lower part of the stomach. Further, there is a risk for the slippage of band which may show symptoms like heartburn or belly pain (Nguyen, et al., 2013). Another risk associated with adjust procedure is that it may cause access port problem, which is a state defined by infection around the access port. Expansion of esophagus may occur as well due to loosening of the bands or stuffing too much food. Other risks associated with lap band surgery are gastroesophgeal reflux disease (GERD) and poor nutrition. Risks following gastric bypass include stomach pouch problem, which may require repetition of the operational protocol. Other risks linked with Roux-en-Y bypass are vomiting due to extra intake; hernia due to twisting of intestine; kidney stones and gallstones (Tice, Karliner, Walsh, Petersen, & Feldman, 2008). Post-operational care Weight loss is only effective in the cases where patients and doctors work together. The role of doctor is pretty obvious, he or she needs to conduct the procedure with precision avoiding unnecessary complications; providing expert opinion; monitoring of patient in post-operation phase; and guiding his or her patient by designing diet plans, and informing the patient with do(s) and don’t(s). A greater responsibility lies with the patient who has undergone bariatric surgery. The patient must follow diet plan strictly, he or she must spend time in performing physical activities recommended by the doctors. As mentioned earlier, there is a dire need for co-ordination between the doctor and the patient, and there should be no hindrance in communication between the two parties. Patients who opt for the adjustable gastric band have to see the doctor more often than the ones who choose the gastric bypass surgery. Generally, patients need to have 10 or more band adjustments to reach the level of restriction which shows optimum performance. On the other hand, in case of bypass surgeries, the procedure is long and more invasive, but it does not require as many follow up meetings, as they required in case of adjustment procedures. Loss of weight doesn’t mean that overlooks his or her basic dietary needs. In case of both the bariatric procedures the absorptive area of the alimentary canal is reduced, therefore, the risk for mal-absorption of key nutrients like vitamins arises (Ernst, Thurnheer, Wilms, & Schultes, 2009). To overcome the restriction in absorptive efficiency of the body, patients are prescribed with bariatric vitamins in the post-operation phase. However, the intake of bariatric vitamins becomes necessary for the patients undergoing bypass surgery, while patients with lap band are also recommended to take them as well but in small amount (Ernst, Thurnheer, Wilms, & Schultes, 2009). Cost From an economical point of view there are also some differences between the two procedures. The cost for the adjustable gastric band surgery varies from $ 10,000 - $ 25,000, provided there is no complication. The charges for undergoing Roux-en-Y gastric Bypass Surgery are $ 15,000 to $ 35,000 (Livingston, 2005). The insurance policies regarding weight loss surgeries vary from country to country, but if the health insurance of an individual covers bariatric surgery, it will cover the expenses for weight loss surgeries (Livingston, 2005). References Ernst, B., Thurnheer, M., Wilms, B., & Schultes, B. (2009). Differential changes in dietary habits after gastric bypass versus gastric banding operations. Obesity Surgery, 274-280. Fisher, B. L. (2004). Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obesity Surgery, 67-72. Livingston, E. H. (2005). Hospital costs associated with bariatric procedures in the United States. Presented at the 29th Annual Surgical Symposium of the Association of VA Surgeons, (pp. 816-820). Salt Lake City, Utah: The American Journal of Surgery . Nguyen, N., Game, P., Bessell, J., Debreceni, T., Neo, M., Burgstad, C., et al. (2013). Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. World J Gastroenterol., 6035-43. Tice, J., Karliner, L., Walsh, J., Petersen, A., & Feldman, M. (2008). Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med, 885-893. Read More