Dr. DeBarros explains the difference between LAP-BAND® and gastric bypass surgeries and discusses why weight loss stabilizes after two years in gastric bypass patients.
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How does LAP-BAND and Gastric Bypass Surgeries Differ? Dr. John J. DeBarros: That’s very simple. A LAP-BAND® is a device that is a purely restrictive device. So, it restricts the amount of food that you can take in. So, you eat; food goes into this upper portion of the stomach here and it will restrict or decrease the amount of intake based on how much fluid and how much actual fluid we have in the band, which will restrict the size, the opening of this inlet into the remaining portion of the stomach. That’s all a band does. A gastric bypass is a different procedure. A gastric bypass is also a restrictive procedure, however, it adds what’s called a malabsorptive component, which we bring up a limb of intestine and we divide the stomach here and so, it has sort of the same sized pouch as a LAP-BAND®, however, that limb of intestine is sutured directly to the gastric pouch. That’s called the gastroduodenal anastomosis. Then we re-route that down distally and we attach it to the small intestine again so that everything is sort of running through. So, in a gastric bypass, your native stomach remains intact. We do not remove the stomach; we just attach a limb of intestine up here. The stomach is completely separated but the intestine is attached there so when you eat, food goes into the small pouch, which is about the same size of a band and then goes, instead of trickling into the stomach, it trickles into the small intestine. Down through the small intestine, there’s an area where you actually cannot absorb the calories because it’s a shorter route. Now, we have created a shorter, a quicker transit from the actual stomach to the colon, so that area is bypassed. So, you get an additional way to lose weight. So typically, gastric bypass weight loss is much more rapid and sustained than LAP-BAND®. However, gastric bypass weight loss typically resolves in about two years and most people stabilize their weight in about two years. Why Does Weight Loss Stabilize After Two Years in Gastric Bypass Patients? Dr. John J. DeBarros: The reason why the gastric bypass patients’ weight stabilize in a couple of years is because A, they have lost a majority of their body mass and the body will then sort of use its metabolism and slow it appropriately to sort of compensate with the actual food intake. So, after a couple of years, the body will sort of equilibrate. Now, gastric bypass patients, just like any surgical procedure patient, including LAP-BAND®, can regain their weight again. The way they do it is you eat and you stretch the upper portion of your stomach, so you will actually stretch this pouch until it becomes so large, it is the same size as your native stomach or half the size of your native stomach and then what will happen is it will just create a reservoir for more food and you get hungry and you eat again. That’s why programs are so important. Having a program we can catch these things prior to starting. That’s why surgery is only half the battle; programs are the other half of the battle.