TECHNICAL NOTE: A SUMMARY OF THE PROS AND CONS OF GASTRIC BYPASS VERSUS ADJUSTABLE GASTRIC BANDING

From the current surgical knowledge, here is a summary of the pros and cons of bypass versus adjustable banding:

- LAPAROSCOPIC APPROACH ('keyholes operation'):
BYPASS:YES, but longer and more delicate procedure.
LAP-BANDING:YES, easily done in 30-45 minutes.

- TECHNICAL DIFFICULTIES :
BYPASS:YES, requiring more training and experience from the surgeon.
LAP-BANDING:NO, now that the procedure is standardized.

- RISKS OF THE OPERATION :
BYPASS:YES, see chapter 'surgery' (bleeding, infection... mortality: 1 to 10/oo)
LAP-BANDING:NO, very low (2-4%, mortality 1/1000)

- LONG-TERM RISKS :
BYPASS:YES (e.g. ulcer)
ANNEAU MODULABLE:YES, band slippage (5%) or erosion through the stomach (2%).

- PROSTHETIC MATERIAL :
BYPASS:NO, except from the staples (they are not an issue).
LAP-BANDING:YES, but they are well accepted. Access-port can be an issue.

- EATING ADAPTATION (quality of the meals)
BYPASS:YES, most often.
LAP-BANDING:NO, more vomiting.

- LONG-TERM EFFICACY (Weight-loss):
BYPASS:YES, better results in terms of weight-loss after 5 years.
LAP-BANDING:NO, but large series show acceptable results.

- LONG-TERM SURVEILLANCE :
BYPASS:YES, e.g. intestinal obstruction
LAP-BANDING:YES, dilatation of the stomach and/or oesophagus.

- SUPPLEMENTATION (vitamins, iron, micro-nutrients):
BYPASS:YES, deficiencies are common.
LAP-BANDING:NO, except if frequent vomiting.

- ALTERATION OF THE ANATOMY :
BYPASS:YES, great changes owing to the fact that most of the stomach and the first elements of the digestive tract are bypassed, thus inaccessible. 
LAP-BANDING:NO, entirely reversible if the band is removed.