Don’t forget the gastric band is the lowest risk procedure!

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It would be true to say that the long-term complication rate of the band is higher than it is for the sleeve or bypass but that is offset by lower short-term complication rates.

This, however, only tells part of the story.

When looking at surgery complication rates it’s important that patients consider the potential severity of complications when they do arise. In the case of the gastric band, most complications can be managed and treated successfully through a simple, day case corrective procedure, perhaps a port replacement or even band removal.

These are recognised complications that are easily treated by an experienced band surgeon. The short AND long terms complications with sleeve and bypass are usually far more severe and the outcomes are unknown. There is the short-term risk of haematoma (bleeding), staple line leakage, stricture (sleeve) and internal hernia (Roux bypass but not Mini bypass).  

The major concern with these complications is that although incidence rates are low when they do occur they are so unpredictable. Often a post-operative haematoma can be linked to or lead to a staple line leak, especially if the bleed was along the staple line. Staple line leakage is a terrible complication when the presentation is later (8 days after surgery or later) as it is rarely possible to return to theatre and simply close the leak.

This is an option when the leak is ‘early’ and the tissue around the leak is relatively undamaged. Those 1 in 80 patients experiencing a leak can expect several weeks in the hospital and there is always the risk of further complications arising from the treatment. In the case of the bypass, long-term complications can arise from vitamin and mineral deficiency, in extreme cases leading to malnutrition. This is avoidable however with vitamin and mineral supplementation and regular blood tests with your GP. These are very important. The later risk we are concerned about in bypass patients is an internal hernia.

This rare but can be life-threatening. Indeed the internal hernia, staple line leakage and haematoma are all life-threatening.

These risks need to be balanced against the relatively safe gastric band. It’s not as powerful a procedure as the sleeve or bypass, and you’ll have to work much harder to get the weight loss results you are striving for, but the safety profile makes it well worth considering. In my opinion, too many people have dismissed the band and promote the sleeve instead.

Both have their place and the sleeve and bypass are excellent procedures. Let’s not forget the value of a safer procedure, however, especially so for younger, generally healthier patients with lower BMI. At your consultation, your surgeon will talk to you about the pros and cons of all the procedures.

Make sure you fully understand them.

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Rishi Singhal

Rishi is an expert bariatric surgeon based in the West Midlands and also Medical Director at Healthier Weight

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