Lap vs. RNY

In the December 15, 2006 issue of my newsletter I printed an email that I had received from a Lap Band patient who was unhappy with the condescending attitude that she perceived on the part of many bypass patients. I asked Lap Band patients to respond, if they agreed or not. I received many thoughtful responses which I am including below and in a linked page.  I hope each of you will read these so they may bring you a better understanding of the issues.

I want to start with the email that I received from my friend, Walter Lindstrom. Walter is an attorney who is a pioneer in representing patients’ rights for insurance coverage of weight loss surgery. Walter has a unique perspective which he shares.

Dear Barbara:
I suspect I'll be one of only a mere handful of respondents (if any) who actually have had both the gastric bypass (1994) and LAP-BAND (2003) surgeries.  Acceptance of the LAP-BAND by payers, practices and other patients seem to be improving over the years, but there seems to be a natural human tendency to favor "what you know" and reject that which is less familiar.  Duodenal switch patients think they have the best procedure; Mini-gastric bypass patients will argue for theirs; bands, bypasses and now you're starting to see sleeve gastrectomies as well.  Everyone wants to validate their own choice - it's just natural.

Surgeons will tell you, if they are being honest with patients, that there is no "one size fits all" procedure.  I've attended many a professional meeting where a main topic of discussion is trying to "match up" the best procedure for a patient, and there is no magic formula, at least not yet.  It is up to the patient to make a choice, in conjunction with his/her doctor (who is obligated to fairly present ALL the options and find another doctor if they don't make a fair presentation!), for that procedure which is best FOR THEM!  If Sue thinks a LAP-BAND is right for her and her doctor agrees, I can tell her from personal experience of BOTH that she is making a great decision FOR HER.  That's all we as patients can do - - make the best decision for ourselves regardless of what that "best decision" was for someone else.

I hope that helps Sue and others out there like her.  It is high time we stop fighting amongst ourselves as patients about "mine is better than yours" when our goals for better health are what really matters, right?

Walter Lindstrom
Obesity Law and Advocacy Center

Dear Barbara,
I feel there is a definite bias against bandsters among bypass patients.  More importantly, there is an assumption that we are all alike and therefore need only follow RNY guidelines. Many times I have been condescendingly asked, “When are you having your surgery?” and other such questions that denote that the person asking is comparing results based on numbers only.

Personally, I wasted 18 very frustrating months scrupulously following RNY guidelines after my lap band surgery and wondering why it wasn’t working for me before I was led to SmartBandsters online. There I finally found the knowledge and support I needed that was unavailable even through my surgeon’s office.  Then I had to unlearn not only old diet rules but the new stuff from bypass follow up.  Fortunately, there is not a window of opportunity with the band and the more I learn how to use it the more effective it becomes.

With RNY’ers the rapid weight loss obviously makes the number of pounds down the first thing they consider.  They don’t seem to consider NSV’s (non-scale victories) very important and do not seem to appreciate (or maybe they just don’t know about) the many things bandsters have to learn in order to use the band as a proper tool.  Bandsters have to address their food issues more directly and sooner as well as develop the patience needed to get to the proper fill level.  In all fairness, there is a certain amount of sarcasm involved in labeling the band “the thinking person’s weight loss surgery” but it is also true that we have many variables that we must deal with.

Actually I finally took Jessie Ahroni’s book to my surgeon’s office and suggested they check it out.  Personally, I believe it should be given to everyone considering lap band surgery until the professionals provide more balanced information to patients.  The after care group is useless, too, as the emphasis is always on bypass patients.  Separate after care groups would be the best situation, but in the meantime having someone on staff who is banded would go a long way toward improving the delivery of this health care system.

Thanks for the opportunity to sound off.

Ann Tevik

Hi Barbara
Thanks for the newsletter.  I have to add my 2 cents worth about the condescending attitude about lap band surgery.  I am pre-op for lap band and have been all over the net looking up support and information to make my surgery a success.  I found a lot of that condescending attitude.  People in many of the forums I went to made me feel that if I was having lap band surgery, then I was not really having weight loss surgery, or they made me feel that I was not having the “best” surgery. 

I did not go into this decision ignorant.  I have done a lot of research on RNY vs. lap band.  I ordered books on weight loss surgery, read a lot of online articles, I even found a website where you can watch an actual lap band surgery being done.

After much research I felt lap band was best for me.  I read the book Lap Band For Life by Dr. Ariel Ortiz Lagardere.  It is an excellent resource for info on lap band and I highly recommend it to anyone considering lap band.  Now when I run into an attitude I just let it go because I am doing what I know is right and best for me.  Information gives us the power to know what decisions we make are right for our situation. 

Thanks again for all your wonderful information and I hope someday you have a retreat in Illinois.  I would be there!! 


Unfortunately Barbara, I feel this is an issue on both sides.  After having my RNY surgery on 03/15/05 and subsequently losing 200 pounds, the topic of how I accomplished such a task became a regular occurrence.  Naturally I would find other weight loss surgery patients by discussing my journey, some who had the same procedure and others who did not.  Throughout the course of these conversations, with Lap Band patients it would almost always end up being geared towards comparison.  Sometime positive and informative, but lots of times I'd eventually feel that with those who chose the Lap Band, they'd find a way to add that they ultimately chose the lap band surgery because it was "safer" and "less invasive," therefore superior to my "drastic" decision.  I've even seen info-mercials and commercials promoting the Lap procedure in the exact same manner.  I think we've all seen them by now.

I personally do not feel that one surgery versus another should be viewed as "superior", but the medical field has unfortunately taken that approach to substantiate the respective surgery to therefore also increase their pocketbooks.  What I mean, really, is that some surgeons do not perform both surgeries, either because of personal or professional opinions.  So for them, it has become a competition for business, if you will.  This has definitely spilled over into mainstream views. 

I really think that we must stick together and realize that even those who have the same procedures end up having dramatically different experiences.  We are all individual persons with a unique individual story.  If a person has sought out medical treatment for obesity and is going to have a procedure to help cure it, by all means they need to be commended for doing so and allowed to choose the tool they feel most comfortable with.  

We should all stop judging one another and trying to position ourselves in a grandiose position because we went a route different from our fellow post-op patients.It truly seems ridiculous that we do this to one another.  Let's think about it before we make disparaging remarks.  I personally would not want someone who has no need for surgery to question my choice, let alone one who has been through the emotional journey.

Thank you.

Dear Barbara,
I had lap band surgery 6/20/06 and in all the preparatory groups and classes, we all were treated equally.  They emphasized the differences to be expected post-op.  They also repeatedly told us although the RNY patients lost weight more rapidly that after three years the banders would catch up.  I chose the lap band because I already had multiple co-morbidities including diabetes, arthritis, sleep apnea, hypertension plus super obesity (over 400 pounds.)  I also liked the idea if a health problem developed, the band could be emptied and refilled later whereas RNY surgery was irreversible. 

We also had multiple groups that met regularly to help us cope with the many things that might interfere with our goals.  There are separate meetings for lap band and RNY each month and every three months we have a joint meeting.  We also have a mentor program available and an online bulletin board (10-40 notes a day, every day). All of this is overseen by the bariatric coordinator who is an RNY success story herself. 

I worked in the medical field for 30 years and I have never seen a more complete and all encompassing program.  Included in the success of the program are endocrinologists, dieticians, psychologists and plastic surgeons.  I wish all bariatric patients could have the opportunity to find a program like this. 


Dear Barbara,
I have found a condescending attitude among others, but not the people I know who have had bypass.  I thank God I was able to have lap band instead of bypass as it is less risky and you can get fills and adjustments that help when you reach a plateau.  Once you've been bypassed there is no tweaking it like the band. 

People who know nothing about bariatric surgery can be annoying......"oh so and so lost x number of pounds, but they did it on their own"....who did it for me?  I believe I was the one who shut my mouth and moved my butt, even though I had the tool of the lapband to help me remember not to overeat and if I do, I pay for it! 

It is still by far the best thing I have ever done for myself and I've gotten my life back.  I feel better, move better, look better and I still have a long way to go!  Thanks for your newsletters.  My surgeon/hospital is an hour away and making support meetings can be a pain.  Having you newsletter to answer questions and just reading about people who know really helps. 

Thanks a lot,
Patty Wood

I would have preferred the lap band, but my insurance would not approve it because my BMI was too high according to their policies.  The doctor that did my surgery would have preferred the lap band as well for me.  I don't look down at Lap Band patients at all.  They have a less complicated surgery, fewer complications, and the opportunity to have that band tightened when needed. (and could be "reversed" if there were some future medical issues).  I see all those things as a plus.  I even think the somewhat slower weight loss could be an advantage. I am glad the Lap Band is available and wish the insurance companies would catch up with the technology.

Mary Ann Holtz

Hello Barbara,
I had the Lap Band done in December of 2005, at The Cleveland Clinic by Dr Philip Schauer.  I was questioning if the banding was the wisest choice because everyone I spoke to had the RNY or was getting it done.  I made me feel like I was making the biggest mistake of my life. I was always second guessing myself, wondering if this was right.  I thought “what if I don’t lose weight” or “what if my band slips”.  I decided to go to some support group meeting but to my dismay there were no lap band patients there to talk to.  I believe you came to speak at the Cleveland Clinic in the winter of 2005 right before my surgery.  Then is when I was fortunate enough to find two patients who had had the lap band surgery performed at St Vincent’s Charity Hospital here in Cleveland, Ohio.  Honestly there are many people who I have spoken with who have said “If you are going to do this you might as well do this right”.  Well I feel the Lap Band was right for me.  Prior to surgery I weight 312 pounds.  With the advice of my surgeon I dieted and got down to 300 pounds on the morning of surgery.  Today almost one year later I am down to 228 pounds which my surgeon tells me is remarkable progress.  In short, I would like to tell all of your readers who have decided to have the lap band but are second guessing themselves, talk it over with your surgeon, and then talk it over with yourself. The band is a tool just like the RNY, it’s slower but believe me it comes with the same benefits.


Dear Barbara,
When I was banded, the FDA was just approving the LapBand and there were very few of us. The majority of weight loss surgeries are still RNY, with the other surgeries all being slighted just because of mere numbers.

Therefore, when support groups/email boards etc assemble most of the conversations seems to be around their needs. Their nutritional needs are different; they lose weight a lot faster, then have different medical needs, etc. Obviously if a lap Bander is in a majority group of RNYer's, our needs will be in the minority.  Lap Banders shoot back about the problems of malabsorption and how much more healthy our surgery is, etc. Yet we have issues also such as band slippage, poor eating that causes stoppages, etc. that RNYers would not be interested in. 

I found out it is best we focus on our similarities, such as dealing with emotional eating, learning to exercise regularly, body images as we lose eight, dealing with relationships as we change, etc.

I don't feel looked down on, just in the minority. Thus I focus on Lap Band boards, support groups that are primarily for Lap Banders, and enjoy the combined groups for our similar issues. 

Barb McGraw