Gastric Band versus Gastric Sleeve
Having made a life changing decision to embark on weight loss treatment with bariatric surgery you need to consider your options as well as the pros and cons of the various operations. We are going to do a comparison between the gastric sleeve and the adjustable gastric band.
Each person is different and when you are considering having surgery it is best to do as much research as possible and take some time to learn about the options to help you decide which one is best suited to your personal situation. Set up an appointment with a bariatric surgeon to discuss your weight loss journey and to ask any questions and to address any concerns that you may have, they normally work with a team so you can also speak to one of the members who will have a wealth of experience working with patients like yourself.
The two operations we are going to look at are the laparoscopic adjustable gastric band (LAGB), which is an operation that involves placing a medical device around the top of the stomach to control hunger and eating, and the laparoscopic sleeve gastrectomy (LSG), also called the gastric sleeve, this is an operation which surgically removes a greater part of the stomach to limit food intake.
So, let’s look at each operation in detail starting with the sleeve gastrectomy.
This a restrictive procedure which limits the amount of food that can be eaten and reduces feelings of hunger. The stomach is reduced in size as, 60-80% of the stomach is physically removed leaving a very narrow tube resembling a sleeve.
During the weight loss phase in the first 1-2 years patients are on 600-800 calories a day which increases to 1000-1200 once patients have reached their target goal weight.
Patients are advised to eat protein-rich foods, avoid high fat and high calorie foods, drink 6-8 cups of water a day and avoid carbonated drinks. Patients are also recommended to eat five small meals a day, avoid snacking and not to eat and drink at same time. They must chew their food thoroughly and not lay down or rest horizontally after eating. It is also recommended that patients take a multi vitamin supplement as well as calcium and vitamin B12.
The operation itself is performed through keyhole surgery and on average takes one hour with an average hospital stay of 2-3 days. Patients need to take 2 weeks off work and the recovery period is 3-4 weeks. Although there is no implanted device the disadvantages of this procedure are that it is not adjustable or reversible and carries general surgical risks which includes blood clots, bleeding, infection, and pneumonia. There is also a risk of leakage at the suture/staple edge line of the stomach and a risk of newly diagnosed reflux disease. Patients are required to make a lot of effort for initial weight loss.
The advantages are that it does not require a medical device implant into the body, the pyloric valve and small intestine are kept intact. The gastric sleeve reduces hunger because the portion of stomach that produces Ghrelin; the hunger stimulating hormone has been removed. Patients have few food intolerances and therefore there is a low risk of malnutrition. The sleeve is an option for patients who do not qualify for band or bypass and can be converted to a gastric bypass for additional weight loss.
In terms of expected weight loss there is a faster rate of weight loss compared to the band. The short term results have been primarily favourable, especially in low BMI patients (BMI 35 – 45). The expected weight loss is an average of 55% of excess weight at 2 years. At the moment long term results are not yet available
Now let’s take a look at the gastric band procedure:
The band is also a restrictive procedure which slows down digestion therefore limiting the amount of food that can be eaten and creating a feeling of fullness earlier with less food. The anatomy is not changed in any way and during the operation a new small stomach pouch is created by placing an adjustable silicone band around the top part of the stomach and the access port is placed just under the skin to enable the clinic to access the port to perform adjustments.
The dietary requirements for gastric band patients are 800 calories per day during weight loss period (2-3 years) then 1000-1200 calories per day, once their goal weight has been achieved. It is recommended to eat protein-rich foods and avoid fibrous, dry, or doughy foods as they can get stuck in the stoma of where the band is situated around the stomach. It is wise to avoid high fat, high calorie foods and carbonated drinks and to drink 6-8 cups of water a day. Gastric band patients need to eat 3 small meals a day, avoid snacking and not drink at the same time as eating. One of the golden rules is to eat slowly and chew their food thoroughly. In terms of supplementation they are advised to take multi vitamins and calcium.
The actual operation is performed by keyhole surgery and takes approximately an hour, in some cases the surgery is done as a day case otherwise it is an overnight stay. Patients need to take a week off work and recovery time is 2 weeks. The band is adjustable and the operation is fully reversible.
The disadvantages of the gastric band are the normal general surgical risks including infection. A band slippage (<5%), band erosion (<1%), or port problems. If inappropriate foods are eaten the stoma can become obstructed causing discomfort and pain. On the weight loss journey the band needs to be filled and adjusted in the clinic by either a surgeon or specialist nurse. Patients need to make an effort to eat in the prescribed way for the initial weight loss to occur.
The advantages of the gastric band are that the operation is simple and relatively safe. It is reversible and adjustable and does not remove or alter any part of the stomach or intestines. The hospital stay is short with a quick recovery period. There is a low risk of malnutrition as well as a low rate of major complications. There is an excellent App called the Bioring Gastric Band which helps to both support and educate the patient on their weight loss journey and is very user friendly.
In terms of weight loss with a gastric band it occurs at a slow and steady rate settling at the final goal weight 2-3 years after surgery. Patients can lose 40-50% after 1 year and 55% after 5 years, there is excellent long term data on gastric banding.
When you are considering your weight loss options remember to keep in mind that surgery is only a tool to help you lose weight and that regardless of which procedure you choose you need to make an effort to change your lifestyle and eating behaviours to be successful.