There are two types of anatomical changes (restriction and malabsorption) created by weight loss surgery. Restriction limits or reduces the stomach volume and malabsorption separates the small intestines into two separate channels. For the past forty years each one of these methods has been applied alone or in combination. Currently, all operations create restriction by making a small stomach pouch. Two operations (Vertical Gastrectomy and adjustable gastric banding) utilize only restriction whereas the other two procedures (Roux-en-Y Gastric Bypass and the Duodenal Switch) utilize both restriction and malabsorption (hybrid procedures).
This year, we have started placing a new type of adjustable band- the Realize band. Patients who are interested in only restrictive procedures, will now need to be and understand their three choices: the Lap-band system, the RealizeBand™ and the Vertical Sleeve Gastrectomy. All of these operations have been present in various forms and techniques for almost 20 years. The lap-band system was first placed in Belgium in 1994 and was FDA approved in the United States in 2001. Our earliest experience with this band dates to the FDA trials in 1998. The Realize band, formerly the Swedish Band (Obtech), was purchased by Johnson & Johnson, then FDA approved in 2007.
Adjustable gastric banding has been used in Europe, Central America and Australia since 1990. To date, more than 400,000 procedures have been performed worldwide. Banding is generally performed in an outpatient setting or only requires an overnight stay in the hospital. Insurance companies do tend to authorize both gastric bands if the patient BMI is greater than 35 Kg/M2. Banding has been shown to be safe and effective enough in medical studies to gain FDA approval. We have found it extremely useful for people who either do not wish to permanently alter their anatomy or who are higher risk patients (many other medical problems or older age groups). It does tend to have slower weight loss, 1-2 pounds per week, and overall less weight loss when compared to other procedures.
Both lapband surgery and Realize band surgery work by creating a point of narrowing at the top of the stomach. There is an inner balloon on the band that can be inflated and thus function to narrow the top of the stomach as needed. Adjustments, also called band fills, and can be done in the clinic. The main difference between the bands is in the design of the balloon. The Lapband ballon is a high pressure, low volume balloon and functions as a more rigid ring. The Realize band is a high volume, low pressure and functions as a less rigid, more weighted ring. The 3 year weight loss results from the FDA trials show that they are similar with 40% excess weight loss being reported.
The other restrictive option that many of our patients seek is the Vertical Sleeve Gastrectomy. This is a stapling procedure and a significant portion of the stomach is removed. It does not have an intestinal bypass, so many patients will choose this procedure as it avoids a bypass yet gives similar weight loss as the bypass procedures.
To date, we have performed and actively follow up on almost 2,000 patients with these three operations. We urge anyone considering weight loss surgery to contact us for further information. We understand that all patients seeking lap band weight loss surgery are in a “research” mode and may not be able to obtain accurate information. Our highest priority is patient education and providing accurate information.
Paul Cirangle, MD
Director, Bariatric Surgery at California Pacific Medical Center