Bariatric surgery, even in the best of hands, is not a panacea, and while most patients report a favorable outcome following the surgical procedure, a significant subset of patients may experience complications or not fail to achieve their ideal body weight as expected.
In these circumstances, a follow-up surgical procedure, known as a bariatric surgery revision, may be necessary to either achieve the ideal body weight, help resolve co morbidities, or manage the complications of the first surgery.
A comparison of the between the Roux-en-Y gastric bypass and lap band surgery becomes exceedingly relevant when considering a bariatric surgery. Whether there are more revision surgeries required after lap band or gastric bypass is therefore an important consideration.
Both of these surgeries are radically different in terms of their mechanism of action. Gastric bypass has a dual mechanism of action, being restrictive as well as a malabsorptive procedure, while the lap band surgery is only restrictive. The former, therefore, has been found to be more effective over time. The weight loss however is slower, and steadier with lap band surgery. The final weight loss is achieved by the end of three to four years after lap band surgery, and by the end of eighteen to twenty four months following the gastric bypass procedure.
Approximately 5 to 10% of patients who have had a gastric bypass reportedly require a revision surgery over 5 years. The reasons for the same vary from complications, unsatisfactory weight loss, or weight regain.
The revision rate following lap-band surgery is reported to be approximately 10% during the first two years. The reasons for the same include device-related problems, slippage or unsatisfactory weight loss.
Collated data from multicentric trials indicates that the excess body weight loss following gastric bypass surgery ranges from 69 to 84% at one year, while the same following a lap band procedure is 45 to 55%. Given that a weight loss less than 50% of the excess body weight constitutes surgical failure, it is evident that the rates of revision surgery following lap band surgery are higher than that following a gastric bypass.
Even though the incidence of early complications following gastric bypass has been reported to be higher than those following lap band surgery(4.2% and 1.7% respectively at the end of first week) the complication rates of the two procedures become comparative by the end of one and a half years (8 and 9.1% respectively).
Experts believe that long-term failure and complications after this time are rare with gastric bypass, while a significant number of lap band patients experience problems which may require a re-exploration or conversion to a different surgical procedure.
However, given that the safety profile of the lap band surgery is significantly better than that of the gastric bypass, and the former is a reversible technique, several patients as well as bariatric surgeons are opting for it. However, when making a choice, the decision must be made keeping in mind the relative rates of revision surgery following each of the surgical procedures.
