Sleeve Gastrectomy vs. the Lap-Band: Which Is Better?

Sleeve Gastrectomy vs. the Lap-Band: Which Is Better?

A frequently asked question:

Is the sleeve gastrectomy a better operation than the Lap-Band to achieve desired weight loss? The answer may surprise you!

The Lap-Band has been around for about 20 years. It involves putting a device around the upper portion of the stomach which is attached to a port which is placed under the skin on the abdominal wall. A needle with a syringe attached can be placed through the skin into the port to add fluid which inflates the band. This makes a small pouch out of the upper stomach which limits food intake and leads to weight loss. The advantages associated with this operation include:

  • patients will achieve 55-60% excess weight loss
  • it is an outpatient procedure
  • recovery and back to work is speedy
  • weight loss is gradual and you are in control
  • little chance of nutritional deficiencies
  • good resolution of co-morbidities such as diabetes, hypertension, and sleep apnea

Disadvantages associated with the Lap-Band:

  • continual maintenance as it does require office visits to adjust the band about 2 to 3 times a year
  • some foods are difficult to eat with the band such as pasta and breads
  • there is a 10-20% reoperation rate for malfunction such as slips, prolapses, and band erosions. Although many can be fixed, others require band removal and possibly conversion to another procedure such as the gastric bypass or sleeve gastrectomy
  • weight regain with poor long-term follow-up and poor lifestyle choices

The laparoscopic sleeve gastrectomy has become a stand alone procedure in the past 10 years. It requires making a narrow tube out of the stomach from the end of the esophagus to the end of the stomach. The extra stomach is removed. It works by limiting how much food can be consumed at any time.

The advantages associated with the sleeve gastrectomy include:

  • patients will get about 70% excess weight loss
  • it requires only a 1 to 2 night stay in the hospital
  • return to work is fairly quick, although a little longer than with the Lap-Band
  • weight loss is rapid and most occurs over the first 6 months and is complete by 1 year
  • good resolution of co-morbidities such as diabetes, hypertension, and sleep apnea
  • little maintenance and follow-up yearly after the first post-op year

Disadvantages associated with the sleeve gastrectomy:

  • 20-25% reoperation rate for weight regain and complications at 5 to 10 years, often requiring a conversion to a gastric bypass
  • lack of long-term data causing us to question whether weight regain will be even higher
  • more expensive operation with it being approximately $14,000

So circling back to the original question: Which operation is best for weight loss? It really depends on which procedure best suits your lifestyle and your expectations. You must view the operation as a tool that will assist you in achieving your desired weight loss and improved health. Both the sleeve gastrectomy and the Lap-Band work very well if you are motivated to be compliant and committed to the process.

We have made this process very easy for our patients. We realize their pain and the problems they have been facing. So our institute and team have tried its best to make things and the whole process easy. Please give us a call at 303-861-4505 if you have questions or would like to schedule an appointment. We look forward to helping you with your weight-loss needs.

Tom Brown, MD
Colorado Bariatric Surgery Institute

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