The last 10 years I have been very busy participating in a lot of meetings around the world. I have found, unfortunately, that we have spent such a long time discussing what procedures are the best for treating obesity that we have forgotten the main point, the core of any of the procedures’ success: the patient.
We all look like fans of a football team, cheering for their favorite team. Some doctors cheer for the Gastric bypass as the best and only option to cure obesity. Then we have the doctors that prefer the lapband as the first option. In another corner, there are the doctors that promote the Gastric sleeve as the new treatment for obesity and Type 2 Diabetes.
There are several good medical reasons involved in the doctor’s preferences for one procedure over the other but also their preferences points toward which procedure the doctor feels more comfortable performing or is more skilful. In Mexico, we have to add to this discussion, the place were the doctor was trained, for instance, if he was trained in the Mexican Health Care System they will know very little about the Lap band and would prefer to perform the Gastric Sleeve or the Gastric Bypass. This is because the Lap band is not yet available for the government hospitals. This means that these doctors started with Bariatric procedures such as the Gastric Bypass 3-4 years ago, and the Gastric Sleeve 1-2 years ago.
I personally recommend the Lap band as the first option. There is less risk for operatory complications involved, it is less expensive and it’s adjustable. You don’t have to be overly obese to have the Lap Band. You can have Lap band revision in case the lapband fails the first time or jump to any of the other procedures available including the Duodenal Switch. The Lap-band also helps in the control of co-morbidities related to obesity such as high blood pressure or Diabetes in almost 6 out of 10 patients.
The arguments against having the Lap band as the first option are valid with patients that have difficult behavioral control such as alcohol abuse. Arguments are also valid for patients that don’t like the idea of having lapband fills done periodically or when there isn’t a doctor or center to do the fills close to where they live. The arguments against the Lapband that are not valid, are erosion rates (less than 2 %), slippage (less than 4 %), or obtaining insufficient weight loss as a strong argument for deciding on other surgical options such as the Gastric sleeve or Gastric Bypass.
There are no “complication free” bariatric procedures. With any bariatric procedure there are advantages and disadvantages. We also found that with all bariatric procedures, there is a chance for insufficient weight loss and a chance that patients may need revision surgery. Mean percent excess weight loss at five years ranged from 48 to 74 % after Gastric Bypass and from 50 to 60% after Vertical Banded Gastroplasty, the same results are for the Gastric Sleeve.
However, with all this in mind, we must remember that the best and most effective procedure will ultimately depend on the individual patient that is looking for a weight loss procedure. The patient and doctor must work together to discover all the facts and make the best informed decision in order to be successful. Don´t rush your decision – get informed!