Join 3,560 readers in helping fund MetaFilter (Hide)


Roux en-Y vs. Lap Band
February 16, 2012 10:38 AM   Subscribe

I have been approved for an essentially free gastric bypass surgery (Roux en-Y), but the extensive surgery/recovery scares me and I would much rather have Lap Band surgery. That won't be covered by my insurance so I'd be paying about $15,000. Can you help me evaluate my options? And personal experience with either surgery would be great.

I live in Ontario, Canada and our health insurance (OHIP) covers Roux en-Y but no other weight loss surgeries (from what I understand). My doctor was unaware of this and submitted a referral for Lap Band surgery, which she felt was the right option for me. I'm fuzzy on exactly what happened, but her request was processed as if she had submitted a request for Roux en-Y instead, which I did not realize until yesterday when I went for the surgery orientation. I'm not under any obligation to proceed with the surgery, but I am approved and maybe six months into a 12-18 month process. In an ideal world (for me), OHIP would cover Lap Band surgery, which is minimally invasive and comes with a much shorter recovery time than Roux en-Y. Since the Lap Band surgery is not covered I'd be paying about $15,000 out of pocket for the procedure. (I have that money, but it's also a substantial sum for me -- certainly not chump change.)

Basically I am wondering if: it is worth it to spend $15,000 of my own money for a Lap Band surgery, or if I should proceed with the much more extensive/substantial Roux en-Y which will carry very minor out of pocket costs. I am worried about the recovery time of the Roux en-Y (the surgeon suggests taking a full month off of work after the surgery) plus the lifelong malabsorption of vitamins/minerals, the higher likelihood of complications, etc etc. My primary goal is to weigh less and be healthier (and of course I understand that the two aren't synonymous).

I am 31, 5' 4" and I weigh 230 pounds. I lost a large amount of weight 6-7 years ago but have since gained it back. It's okay to make alternative suggestions but please keep in mind that I'm asking for information about these two surgeries, not information about how easy it is to eat less/move more.
posted by anonymous to Health & Fitness (15 answers total) 8 users marked this as a favorite
 
There is a group on LiveJournal for people who have had weight loss surgery, and many people have posted there about their experiences with each surgery. There are also extensive message boards at ObesityHelp.com.
posted by Sidhedevil at 10:49 AM on February 16, 2012 [1 favorite]


[I know you have the best intentions but I think the OP was pretty clear that she is looking for answers to her question about surgery, not diet suggestions.]
posted by jessamyn at 10:54 AM on February 16, 2012


My wife had a roux-en-y almost exactly two years ago. She had zero complications from her surgery, took three weeks off from her relatively physically demanding job (10 hour shifts as a veterinary technician) and had little to no problems with having sufficient energy and endurance at work. She has lost over 100 pounds, with no deficiencies or serious dietary problems (she takes a multivitamin designed for bariatric patients and a calcium chew daily). She had a couple instances of "dumping" after overdoing it with sugar, but she still has a piece of chocolate or bowl of ice cream every now and again with no difficulties.

Her understanding (from her doctor, who performs both) is that complications are actually more common with Lap Band, but tend to be less serious when they do occur. The Lap Band requires more self-control, and less overall weight loss.

Literally everyone she knows (say 3 or 4 people) who have had a Lap Band now wish they had gone with the roux-en-y. She would probably still recommend a bypass that would cost you $15,000 over a free Lap Band, if your situation were reversed.

Please let me know if you have more specific concerns and I can try and answer them myself or pass them along to her. One thing that is true about bariatric surgery in general is that having a strong, committed support system in place is very helpful, and I am glad to have been that for my wife.
posted by Rock Steady at 11:00 AM on February 16, 2012 [1 favorite]


While recovery is felt to be slightly longer with bypass than lap-band they're around the same - I'd expect a surgeon discussing banding with you to suggest a similar sort of amount of time off work. You'd perhaps be able to be back at work in three weeks rather than four, but it's still a substantial chunk of time out. I wonder if you've been given an optimistic version of recovery for banding and a pessimistic one for bypass, making the difference seem bigger?

Here's a nice pros-cons table from the NHS - obviously not personal experiences but a good layout of the issues together.
posted by Coobeastie at 11:03 AM on February 16, 2012


Literally everyone she knows (say 3 or 4 people) who have had a Lap Band now wish they had gone with the roux-en-y.

That certainly seems like the consensus from the LiveJournal group, too! I was honestly kind of surprised by the OP's having received the opposite "conventional wisdom."

OP, I would really get onto the forums I linked (and ask if there are others!) and read as many stories and ask as many questions as you can. The experience I had as a researcher was that this is an incredibly open community of people who are willing to be super-candid with other potential patients (and with me, a random writer who is to put it mildly skeptical about bariatric surgery).
posted by Sidhedevil at 11:15 AM on February 16, 2012


My wife really appreciated the videos and forums at BariatricTV.com when she was planning her surgery. They have a good sense of humor about it all (they call themselves "surgically altered freaks") and a lot of good, unbiased information.
posted by Rock Steady at 11:19 AM on February 16, 2012 [1 favorite]


I can for the first time say without a shadow of a doubt on Metafilter that I AM A ..... Bandster and .... a bit more besides....

If your surgeon/fillprovider (AKA the expert who adjusts your band) is an easy journey and doesn't cost the earth, there is no way in hell you would have a surgery that is multiple- times more dangerous and in my experience of 8 years in bariatric surgery (I don't do the surgery, I advise on policy and have attended mutliple courses in complications and emergencies of same) can lead to intestinal failure and death.

Declaration of interests:Privately, I see people for lapband adjustment and advice on an almost weekly basis. I have a lap band. I am not associated with any company that provides the different bands. My job has something to do with surgery policy.

In the hands of an expert a band is so much safer than RnY that I just couldn't advise in favour of significant re-plumbing. Paul O Brien and John Dixon's work over 18 years of patient follow up with bands shows that none of the common misapprehensions can be data evidenced: e.g. "ahh, you a sweet eater, you have bypass, ahh u a grazer you have bypass, ahh u mildly eating disorder, you need bypass...."

I am so sick of the stereotypes. The secret is a lot of surgery is not evidence based because it didn't need to be, "Ohh you have tumour, whip it out, ohh you have appendix, whip it out...."

so bariatric surgery is FAR FAR more about the level of aftercare you can expect. (since it is as safe in a bariatric centre that does good numbers as gallbladder surgery, ask the surgeon how many of each has he/she done?)

IF your system allows lifelong aftercare, close to where you live, then go for a band. And expect about 5 adjustments of your band before you get to "sweet spot" and then about 1 or 2 adjustments per year.

Now in Canada I've just been to a course where one Canadian big hitter was appallingly insulting about bands because the majority of his patients came from different timezones and so could not get the kind of aftercare (tweaking) that their bands needed.

I was appalled to hear him talk about the latest research in banding (it is not really about restriction, it is about slowing the passage of food through the pressure point created by the band at the top of the stomach near the Oesophago-gastric juncture where the passage of each portion of the food that breaks off from one bolus you swallow creates a pressure on the afferent nerves at the top of the stomach that signal to your brain that you are getting full) as the "tickling, he-he-he of the afferent nerves...seriously I was appalled that a big name was so conditioned by his own practice experience that he was unwilling to listen to some pretty convincing research...............aargh! I was also in the weird position that I knew this was how my band worked, (operated 2005) before the research came out, so I wanted to say "actually, one small bowl of anything eaten over 15 minutes triggers satiety, whether that's salad, prawns and avocado, or ice cream, ((actually that last one slides past your band and doesn't trigger satiety which is why some people don't do as well as others!))


OK as you ARE in Canada, if you cannot arrange for proper band adjustments, then go with the RnY (did you know Roux got the honour because the trainee who pioneered the procedure wanted to marry Roux's daughter and that was part of the agreement, sheesh!)

All I can say is that most of the complications from banding are "take a few mls out, wait a while, put some back in" -It is a completely adjustable system. I cannot say the same of RnY and have seen people die of RnY complications.

HOWEVER CAVEAT: the incidence of follow on surgery with banding is about 20% in the current literature if the follow up isn't lifelong. When I hear of people who think banding is about vomiting regularly and barely being able to swallow their own saliva I want to weep. They have not been optimally adjusted, I've even seen people here on metafilter say, a friend of mine can't eat properly.....please, I would be a size 00 if I couldn't eat properly. To my husband's intense delight I'm curvey. and that;s because I have a band that allows Green Zone eating

Please, please, please google Paul O Brien, his Youtube videos on Green Zone/Red Zone eating.

What I have observed is that surgeons LOVE putting in bands but don't very much like the messy, tweaky aftercare needed. (and by aftercare a "blind" office fill is a 5 minute procedure akin to taking bloods, anyone who insists on X-ray guided fills, you explain why despite evidence that there is no difference from blind fills you are willing to expose your patients to all those extra X-Rays, oh, yeah, your radilogist colleagues need some private practice income too... sweet!)
if they have a team of dieticians, fill adjustment/ fillprovider nurses etc., to look after the tweaking, then the results are awesome for what is effectively in the hands of an expert and very straightforward 45-mins-1.20 procedure.

I have been on the committee of a national bariatric charity here in the UK and a huge number of people have no difficulty with their RnY outside of the lifelong need for proper supplements, but I have seen enough serious complications that I apply the Relative test:
If a relative of mine asked me to recommend..... I would never allow my sisters (who both need bariatric surgery for Type 11 diabetes and seriously high blood pressure) to have an RNY if a band were availible.

the differences between bands themselves (Swedish is better than most in my experience moderating a banding forum, can I be sued for this??) is no-where near as important as the aftercare. If you get it tweaked as often as you need it will work.


Sometimes we use the image of a car: bands are like a car without gas, this is the only surgery you will undergo that has no theaputic value, it simply puts an implant in your body that then needs to be optimally adjusted to suit you : NOT your provider with a rigid scale of adjustments ("oh, we only put in 0.5mls every 6 weeks and if its not working you just need a bit of will power, shame on you" Bullshit! Bands are as unique as the anatomy they surround, what makes a huge difference to one person at 1ml of fill will be awful for another who needs tweaks of 0.5mls or even (private correspondance with Paul O Brien last week) 0.1-0.2mls, ---that's like three drops of water!

BUT another thing you need to realise and this is probably the most complicated part, the averages say about 70% of people lose 50% of their Excess Body weight. I'm convinced (again look at O'Brien and Dixons' results : the longest patient series in the world- 18 years which is phenomonal in bariatric terms; so many authors report on patient series of 3 years and don''t include those lost to follow up LFUs: FYI anyone lost to follow-up should be included as a failure but that doesn't happen in the majority of studies of bariatric surgery as they are trying to sell you something) that when optimally adjusted bands can do as much as RnY despite the earlier faster weight loss results with RnY.

oh, and the 10 year stats show an evening out of total excess weight lost no matter which surgery you choose. Bands take longer in the first 2 years and the RnYs show a little uptick at the 2 year mark bringing it back to parity (and by the way making RnY people feel they have "failed" sometimes leading them to comfort eat and regain all of thier weight)

with all the evidence, if a band doesn't suit, you can convert in a few years to one that surgically re-plumbs your digestive tract, irreversibly for the most part? I have seen so many issues of malabsorption (including inability to have anything but long term runs and worse) that I can't in all honesty recommend RnY as a first step rpcedure:

However the UK Charity WLSinfo.org.uk has the most amazing 9 years worth of petient foums, unallied to any professional providers (they allow a bit of advertising on their front pages to keep the site free to use by everyone but the moderation is completely independant of industry)

(and if you do decide on RnY because you live timezones away from your band adjuster, make sure you 1: join WLSinfo.org.uk and ask lots of questions, after you read the forum stickeys ! ) and 2: make sure they close ALL the internal spaces, tell them ," Peterson's Hernia?, not me, sunshine? you close all three of those internal spaces or else!"

(stepping off my soapbox now, happy to provide stuff by PM which may just protect my job!)
posted by Wilder at 12:38 PM on February 16, 2012 [3 favorites]


and for those previous posters, where an RnY works well, they do better than bands long run, but where they don't work well,......................
Mike has to take 8 sachets of anti-constipation powders every day and is so sensitive to dumping syndrome that he has been hospitalised when there was a tiny amount of sugar in a coffee preaparation at work that was meant to be sugar free (fructose, and sugars put Mike into almost diabetic coma, but when the ambulance picks him up they think he is either having a heart attack, or having a hypo so he has to wear a medic alert bracelate as treatment for a Hypo would kill him). One surgeon's patient was arrested by the Police for Drunk & disorderly whle she was in dumping syndrom
Daniel has the runs every time he eats hot food and after 3 years of investigations the option is a revaersal, Susan is lying down in bed most of the day with "pseudo" Hypo symptoms caused by her RnY, these are just the people I know from my local support group, and I have to multiply that by all the goups in the UK...

now I know we are in an earlier stage of development here in the UK but I still assert that the complications of significant anatomical re-plumbing way outweigh the complications of banding. Band patients are simply not told that they will need a lot more "tweaking" than their RnY cousins and that's a shame, because as you've seen with other posters bandsters are constantly comparing their experience to RnYers.
The FDA recently took action against a company in CA that was mis-selling banding. Something like Ring 1800 thin, or somesuch nonesense.
It is major abdominal surgery, done laporoscopically, with the sole aim of implanting a device that (OPTIMALLY ADJUSTED) will effect a reveral of the damage of obesity.
It is a worry to me to see ads in the back of womens magazine essentially putting banding on par with Botox or a Blepharoplasty...it's NOT COSMETIC surgery. But it is at the moment one of the best therapes we have for Obesity, NOT overweight, not people who can lose weight through diet and excercise and keep it off....no; for obesity and related health issues like Type 11 diabetes.
posted by Wilder at 12:56 PM on February 16, 2012


sorry to anwer more parts of your question:
would $15,000 cover ALL the band aftercare? How much would it cost you to get to your fillprovider? Lifelong aftercare is the ideal but not often offered privately.
DO NOT buy into a 1 year or 2 year packange of fills. especially as many providers set terms, postpone adjustments, etc., leaving the patient feeling it is their fault they are not losing weight and being demoralised enough to give up on their band and say, well the band didn't work for me.....
I must have seen over 100 people over the last 4 years who thought the band didnt work for them and I discovered the aftercare of the band was substandard.

so yes, if you don't have good aftercare (log-on t WLSinfo.org.uk and peruse the stickys on the banding Forum) then take the RnY option.
posted by Wilder at 1:06 PM on February 16, 2012


I knew someone who got gastric bypass and researched all the procedures very extensively beforehand. She was not a fan of the lapband, I don't remember all the reasons why but she said there were a lot more complications and it had the potential to essential cause a hole on your stomach. She highly recommended Weight Loss Surgery for Dummies. I'm no expert at all so take what I say with a grain of salt, but I just am commenting to say that the lapbands benefits may be offset by the side effects and it may not be as superior of an option as it sounds. There are apparently many books and articles, I would buy a few and spend the weekend reading them.
posted by whoaali at 2:52 PM on February 16, 2012 [1 favorite]


I had RNY and few complications. It isn't for everyone; I wanted something permanent, and I didn't want an implant.

I would say two things: don't have surgery you're not comfortable with, and there are a disproportionate number of horror stories online. You hear about the bad stuff, not always the good stuff, and sometimes the bad stuff is the patient's own doing (like a friend who got an ulcer by drinking a lot of coffee at 3 months out). Take stories from a patient's first year with a grain of salt, because it gets much easier after that (not that horrific constipation is ever fun but it doesn't normally last forever). A lot of people live relatively normal lives with RNY. But, do what you will be comfortable with.
posted by cabingirl at 2:52 PM on February 16, 2012


the incidences of erosion & slippage with banding have dramatically decreased as teams learn more about how it actually works and tweak the design of the implant, and more importantly patient education, to suit.
Quite simply patients have been done a massive disservice in the past by people who placed bands and did not give adequate follow up. If you can't secure life-long follow up, or if the thought of adjustments freak you out (one of the ladies I see regularly is needlephobic. and she has a band) then do consider RnY.
Another consideration should be Sleeve gastrectomy if the surgeon/centre you go to is outside the learning curve (the first 50 procedures).
posted by Wilder at 2:25 AM on February 17, 2012


poster I've just dug out my notes from a training course last year where Chris Coates from Ontario was one of the main speakers. He and his team use the O' Brien/Dixon approach that I linked to above and are reporting similar outcomes. They do banding as a day case procedure and unless your job is very physically intense you could be back at work within a week or 2.
More importantly I believe they offer lifelong follow up and provide the kind of band adjustment that I spoke about. Obviously I have no connection with that centre. Feel free to memail me if you want to talk it through.
posted by Wilder at 2:37 AM on February 17, 2012


RNY gastric bypass in 1997 here.

BEST DECISION I EVER MADE, hands down.

No complications, nice weight loss, have kept most of it off (285-160 - presently about 190) and found that the limitation of what I can eat at one time has helped significantly.

I was off work two weeks (wish I had taken more time but it was what it was) and found that I was tired as hell (took wee naps in the supply room!) but got through it. Six weeks post op is when you begin to feel like yourself again.

I don't know what advances have been made in lap band surgery in the intervening years but those who had it around the same time as I had my RNY regretted the hell out of it.

My advice: go for the RNY.

PM me if you want all the deets. I'd do it again in a heartbeat. Truly.
posted by Mysticalchick at 6:05 AM on February 17, 2012


I know one person who has had lap band. She only lost 30 lbs or so and really, really regrets it. It's 8-10 years later and she is still battling.

I don't know if I know anyone who has had RNY but I do know a few who have had various gastric bypass operations and I've never heard any of them complain. They are of various weights, heights, and ages.

Someone else I know has considered going out of pocket for the sleeve, but then she would also be responsible for cash OOP for any complications or problems that happen because of the way her insurance policy was written. You might want to see if that's the case if you go forward with the lap band.
posted by getawaysticks at 6:44 AM on February 17, 2012


« Older How much would facebook need t...   |  Small business owners: Is it p... Newer »
This thread is closed to new comments.