Comparison, Which is Best?
In the world of surgical treatment of obesity,laparoscopic adjustable gastric banding (LAGB)andlaparoscopic gastric sleeve (LGS) surgeriesare successful operations that have proven to be effective in achieving weight loss. Improvement also accompanies the weight loss is obesity-associated disease conditions leading to improvement in the quality of life and overall survival.
Nevertheless, they differ in so many aspects and taking a final decision on which one to go for may be challenging, thus, requiring an in-depth knowledge and understanding of the pros and cons of these two surgeries.
Which is Best? Pros and Cons?
- Least Invasive:Gastric Sleeve Surgery
- Highest Expected Weight Loss:Gastric Sleeve Surgery
- Lowest Complications:Gastric Sleeve Long-Term, Gastric Banding Short-Term
- Least Side Effects:Gastric Sleeve Surgery
- Lowest Cost (Typically):Gastric Sleeve Surgery
- Highest Reduction in Comorbidities: Gastric Sleeve Surgery
Renew Bariatrics recommends Gastric Sleeve Surgeryfor a majority of reasons, primarily that it provides sufficient expected weight loss. Lap-Band removal is also required to be removed about 1 out of 10 patients.
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Gastric Sleeve vs Gastric Banding
 |  | |
|---|---|---|
| Gastric Sleeve Surgery | Gastric Banding Surgery | |
| Method of Weight Loss | Restrictive | Restrictive |
| Duration of Procedure | 1.5 Hour | 1 Hour |
| Length of Hospital Stay | 2 Nights | 2-3 Nights |
| Estimated Weight Loss | 65% of Excess Weight | 45% of Excess Weight |
| Weight Loss at 1 Year | 60-70% | 40-55% |
| Comorbidities | High Resolved Rate | Some Resolved Rate |
| Hypertension Resolved | 68% | 43% |
| Diabetes Resolved | 55% | 60% |
| Migrations Resolved | 40% | Some |
| GERD Resolved | 50% | 87% |
| Mortality | 0.1% | 0.1% |
| Asthma | 90% | 82% |
| Sleep Apnea | 62% | 85% |
| Depression | Most Resolved | 57% |
| Quality of Life Improved | 93% | Most |
| Common Complications | Staple Line Leaks 0.5% | N/A |
| Common Side Effects | Nausea, Digestive Issues | Band Erosion, Band Intolerance, Band Slippage |
| Recovery | 2 to 4 Weeks | 4 to 6 Weeks |
| Cost: Self-Pay Average | $18,000 | $25,000 |
| Cost w/ Renew Bariatrics | $4,399 | Not Offered |
Mechanism of action
Both gastric banding and gastric sleeve are restrictive procedures. They both reduce the capacity of the stomach leading to an early feeling of fullness and reduction in the quantity of food intake. In gastric banding, the stomach is partitioned into an upper smaller pouch and a lower larger pouch with the use of a silicone band. This band is inflated with sterile water, and the quantity of the water can be adjusted, hence the name LAGB. The upper pouch functions to accommodate a small amount of food and pass it to the larger portion bit by bit.
In gastric sleeve, the stomach is reduced to 1/5th of its original size by cutting away 4/5th. One significant difference here is that gastric sleeve is accompanied by a reduction in ghrelin (a hunger hormone). However, while LAGB can be reversed,LGS is irreversible.
Methods/duration of surgery
Although open surgery can do gastric banding and gastric sleeve, both procedures are commonly performed by a laparoscopic approach where equipment with the camera is introduced into the abdomen through small incisions. The duration of LAGB is slightly shorter than that of LGS (94min vs. 116min). The average length of hospital stay for LAGB is also shorter than that of LGS by one day. [1]
Cost of surgery/insurance coverage
This varies by countries and hospitals. Thecost of LAGB is $18,000 ($15,000 to $24,000) in the U.S., while that ofgastric sleeve surgery is $15,000 ($12,000-$20,000). They may be done at lower costs outside the U.S. most insurance policies cover both with slightly different requirements for approval.
Results
The outcomes of weight loss surgeries are measured by the percentage of excess weight loss, the degree of improvement/resolution of comorbid conditions, the risks of complications and the risk of death. Although both surgeries are safe and efficient, the following differences have been noted as regards their outcomes:
Expected weight loss
Wang et al. in their review of many earlier studies found that the percentage excess weight loss at 12 months after surgeries were 37.8% and 51.8% for patients who underwent LAGB and LGS surgeries respectively. [2] The average percentage excess weight loss expected in patients who didgastric sleeve surgery was 59%while that of patients who didgastric banding was 49% at 18-24 monthsafter the surgery. Thus, gastric sleeve surgery offers a higher weight loss than gastric banding.
Reversal of comorbid conditions
Diabetes mellitus improved in more patients after gastric sleeve surgery than after gastric banding. Wang et al. reported improvement in type 2 diabetes mellitus is 82.5% of those who underwent gastric sleeve surgery and 61.8% of patients who had gastric banding. Omana et al. also reported a higher resolution in type 2 diabetes mellitus (100% vs. 46%), high blood pressure (78% vs. 48%) and reduction in bad lipids (87% vs. 50%), in people with gastric sleeve surgery than those with gastric banding. The resolutions/improvements in other disease conditions (gastro-esophageal reflux disease, osteoarthritis, sleep apnea) were noted to be the same. [3]
Complications
Complication rates are higher after gastric sleeve surgery than gastric banding. The postoperative complications of gastric banding include nausea, band migration, band leakage and incisional hernia.Common complications of gastric sleeve surgeryare leakage from staple line, intra-abdominal bleeding/abscess, heartburn, etc. Nutritional deficiencies are rare and similar in both operations. Although the risk of death from all weight loss surgeries is minimal, that of gastric sleeve surgery is even lower with gastric banding having the most moderate risk of mortality.
In summary, the comparison between laparoscopic adjustable gastric banding and laparoscopic gastric sleeve surgeries is as shown in the table below:
Parameters | LAGB | LGS |
Mechanism of weight loss | Restrictive | Restrictive |
Reversibility | Possible | Impossible |
Duration of procedure | Shorter | |
Length of hospital stay | Shorter | |
Cost | Lower | |
Estimated weight loss | Higher | |
Reversal of comorbid conditions | Higher | |
Risk of complications | Lower | |
Risk of death | Lower |
In conclusion, gastric banding and gastric sleeve surgeries are both effective at inducing weight loss and reversal of comorbid conditions. While gastric banding is reversible and has lower risks of complications, it is relatively more expensive than gastric sleeve surgery. On the other hand, gastric sleeve surgery is cheaper, causes more weight loss and better improvement in obesity-associated disease conditions but associated with higher risk of complications.
- Varela JE. Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding for the Treatment Severe Obesity in High-Risk Patients. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2011;15(4):486-491. doi:10.4293/108680811X13176.
- Wang S, Li P, Sun XF, Ye NY, Xu ZK, Wang D. Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Adjustable Gastric Banding for Morbid Obesity: a Meta-analysis. Obesity Surgery. 2013;23(7):980-986. doi:10.1007/s11695-013-0893-3.
- Omana J, Nguyen S, Herron D, Kini S. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surgical Endoscopy. 2010;24(10):2513-2517. doi:10.1007/s00464-010-0995-0.
Please contact our helpful, knowledgeable patient educators who can help guide you through the entire process of getting approved forMexico Weight Loss Surgery.
With expertise rooted in extensive research and medical understanding, let's delve into the comparison between laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric sleeve (LGS) surgeries for obesity treatment. Both procedures have proven efficacy in weight loss, enhancing overall health and quality of life.
Mechanism of Weight Loss: LAGB and LGS are both restrictive procedures. LAGB involves creating an upper smaller pouch and a lower larger pouch using a silicone band, adjustable by sterile water. Contrastingly, LGS reduces the stomach's size by removing approximately 4/5th of it, accompanied by a reduction in ghrelin, a hunger hormone. While LAGB is reversible, LGS is irreversible.
Procedure Duration and Hospital Stay: LAGB typically takes around 1 hour with a hospital stay of 2-3 nights, while LGS lasts approximately 1.5 hours with a stay of 2 nights.
Cost: LGS is generally more cost-effective, with an average self-pay cost of $18,000 compared to LAGB's $25,000. However, costs can vary based on location and healthcare facilities.
Weight Loss and Comorbidities: LGS tends to offer higher weight loss (60-70% of excess weight) compared to LAGB (40-55%). Moreover, LGS shows better resolution of comorbidities like diabetes, hypertension, and GERD, among others.
Complications and Side Effects: LGS has a higher risk of complications such as staple line leaks, intra-abdominal bleeding, and heartburn, while LAGB complications include nausea, band migration, and leakage. Mortality risks are minimal but slightly lower with LGS.
Numerous studies, including those by Wang et al. and Omana et al., consistently highlight the superior weight loss and resolution of comorbidities with LGS over LAGB. For instance, diabetes improvement rates are notably higher (82.5% for LGS vs. 61.8% for LAGB).
While both surgeries offer weight loss and health improvements, choosing between them involves considering factors like reversibility, cost, expected weight loss, and associated risks. Renew Bariatrics favors LGS due to its higher expected weight loss and resolution of comorbid conditions.
The decision ultimately rests on individual circ*mstances, medical advice, and a thorough understanding of the pros and cons of each procedure. Factors such as affordability, long-term health goals, and risk tolerance play pivotal roles in selecting the most suitable option.
The bibliography provided contains valuable research articles (Varela JE, Wang S, Li P, Sun XF, Ye NY, Xu ZK, Wang D, Omana J, Nguyen S, Herron D, Kini S) that further support and elaborate on the comparative analysis between LAGB and LGS surgeries.
This information aims to guide individuals seeking weight loss surgeries, highlighting the nuances and differences between these two prominent procedures.
