Should band patients convert to sleeve or bypass?
Bariatric surgeons interviewed for this article were reluctant to say that all people who had gastric band procedures should convert to gastric sleeve or bypass. But they made it clear that sleeve and bypass procedures are safer and more effective than gastric band surgery, which is why it is rarely done today.
“If a patient experiences poor weight loss or complications from a band, they can consider conversion/revision to a sleeve or bypass,” said Dr. Courcoulas, echoing the views of other doctors.
“The choice of revision procedure should be based on patient factors, including diabetes and total weight. Converting a band to a sleeve is a technically easier operation, and some studies show that there are fewer complications, compared to conversion to a bypass. These considerations need to be balanced with data that show that both weight loss and metabolic improvements such as diabetes are greater after bypass, compared to sleeve.”
Doctors and experts also say it’s important for patients who are considering a gastric band conversion to gastric sleeve or bypass to understand the differences among these three primary procedures, all endorsed by the American Society for Metabolic and Bariatric Surgery.
Here’s a primer, including the pros and cons of each procedure:
Gastric band
In gastric band surgery, an adjustable gastric band made of silicone is placed around the top part of the stomach, creating a small pouch above it, to limit the amount of food a person can eat. The size of the opening between the pouch and the stomach can be adjusted with fluid injections through a port placed underneath the skin.
Food goes through the stomach but is limited by the smaller opening of the band.
Advantages:
- Lowest rate of complications right after surgery.
- No division of the stomach or intestines.
- Patients go home on the day of surgery, and recovery is quick.
- The band can be removed, if necessary.
Disadvantages:
- The band may need to be adjusted from time to time, and patients must make monthly office visits during the first year.
- There’s less weight loss than with other surgical procedures.
- It comes with the risk of band movement (slippage) or damage to the stomach over time (erosion).
- The surgery means that a foreign implant has to remain in the body.
- It has a high rate of reoperation.
- The surgery can bring swallowing problems, enlargement of the esophagus, and other complications.
Gastric sleeve
For laparoscopic sleeve gastrectomy – often called gastric sleeve – surgeons remove about 80% of the stomach, so the remaining stomach is the size and shape of a banana.
The new, smaller stomach holds less food and liquid, reducing how much food (and how many calories) the patient can get. By removing the portion of the stomach that produces hunger and appetite hormones, the surgery also helps reset the body’s metabolism – decreasing hunger, increasing feelings of fullness, and allowing the body to reach and maintain a healthy weight as well as control blood sugar.
Advantages: