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We perform both adjustable gastric banding (the Band) and Roux-Y gastric bypass by laparoscopy. The hallmark of the Band is safety but this comes at a price: device related problems requiring more surgery, the need for adjustments and slower early weight loss. Some insurers do not cover the cost of the device (about $3500) which will need to be paid for by the patient.

Gastric bypass (depicted in the sketch on the right) is followed by more rapid initial weight loss without the nuisance of the device related problems of the Band. It is a far more major procedure with the potential to produce major complications. The reported mortality in the United States is about 0.5%.

What operation is recommended will depend strongly on your personal preference and comfort with the various risks and inconveniences of the methods available. At present there is no reliable way to predict in advance which is best for any given individual. It is thought that patients whose excess calorie sources include simple carbohydrates in large quantities ("sweet eaters") may not lose weight well after the Band. Eliminating simple carbohydrates requires the sort of behavioral changes that have been unsuccessful in the failed dieting that always precedes bariatric surgery. Ice cream, chocolate, and other high calorie liquifiable foods can pass straight through the banded stomach and will prevent weight loss if this type of eating behavior is not curbed. These are serious considerations when deciding which operation to have.



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