If you find trying to work out the differences between the Band and the Sleeve rather confusing, you’re not alone! Here is a brief overview of the differences between these two weight loss procedures:
The Gastric Band
The Gastric band is a soft silicon collar that is placed at the top of the stomach. Unlike the Sleeve, the band does not make your stomach smaller; rather it changes the way signals are sent to your brain when you eat. Our stomachs are lined with nerve endings which sense when we eat and how much we eat. These nerve endings join together to form two nerves called the Vagus nerves, which carry this information to the part of our brain called the Hypothalamus – this is the control centre for appetite. The Gastric Band appears to modify these signals so that we feel less hungry and become satisfied with smaller portions. This effect can be fine-tuned through adjustments.
Unlike the Sleeve, the Band does not reduce the physical size of the stomach- Instead it modifies the signals that are sent to the brain so you feel less hungry and become satisfied with smaller portions
However, because the stomach still has the same overall size, the Band will not prevent you from consuming too many calories. This is especially true if the calories are soft or liquid, which will just slide through the band, even if it is made very tight. And because weight loss will only occur if your calorie intake is reduced, the Band will not work well if you continue to consume a large amount of liquid calories. The Sleeve on the other had will restrict all types of calories to some degree, which may be more suitable if you have trouble reducing your intake of soft drinks, ice-cream, chocolate or alcohol.
The Band does not restrict soft or liquid calories. It is just a tool that reduces hunger and the amount of solid food needed to feel satisfied.
The Band is essentially just a tool that makes you less hungry and satisfied more quickly. It’s still up to you to watch your portions, make better food choices, and exercise regularly. It requires effort and commitment toward lifestyle improvement. In our experience, the Band is most suited for people who can usually lose weight quite easily but just have trouble maintaining it, and generally make good food choices but have a problem with being hungry all the time or needing big meals to feel full.
The Band has several advantages over the Sleeve: it is safer, can be adjusted or even emptied completely if ever required, and can be removed. However, just because it can be removed does not make it any less permanent than the Sleeve. It is designed to be left in place for long term.
The Band is the safest form of weight loss surgery, and although it can be removed, it is intended for long term use.
The main downside of the Band include the need for regular adjustments (every 4-8 weeks) in the first year or two (then just once a year after that), and the small risk of long-term device-related problems such as slippage, erosion or port/tubing issues, which may occur in up to 10% of patients. Fortunately, these problems are usually quite straightforward to fix, and have reduced significantly in recent years due to improvements in Band design, surgical technique and aftercare.
Although device-related problems can occur long-term with the Band, these are usually easily corrected and have become less common.
The Gastric Sleeve
Unlike the Band, the Sleeve does not involve prosthesis inside the body. Rather, the Gastric Sleeve is the permanent removal of a part of the stomach organ. Although approximately 80% of the stomach is removed, the remaining 20% (about the size of a cup) still functions as the stomach should: it’s just smaller. It also results in the reduction of the hunger hormone Ghrelin. Gastric acid and Pepsin still continue to be produced to assist in the breakdown of food, and Intrinsic Factor still continues to assist in the absorption of Vitamin B12. The Sleeve is completely different to the old ‘stomach stapling’ operation of the past, as well as the Gastric Bypass. The small intestine is not altered; therefore, there is no risk of mal-absorption of protein, vitamins or minerals.
The Sleeve simply reduces the size of the stomach organ. It does not interfere with the absorption of nutrients.
Because the physical capacity of the stomach is reduced, the Sleeve restricts the intake of virtually all calories, both solid and liquid. This makes it more powerful than the Band, and may be more suitable for people who eat a lot of chocolates, ice-creams, sweets, soft drinks and alcohol. However, regular consultation with experienced psychologists and dieticians is still needed to address the underlying reasons for this.
The Sleeve can even restrict the intake of soft and liquid calories which makes it more suitable for emotional eaters, especially when combined with the help from experienced psychologists and dieticians to overcome the underlying issues.
However, the Sleeve will only work for people who can manage their food intake or can consume only soft and liquid food. For people who mostly get their calories from solid food types, the Band works very well. The main disadvantages of the Sleeve include the higher risk of serious complications in the short term (about 1:100 vs. 1:500 for the Band) such as leak, and the possibility that the stomach may stretch in the long term leading to the possibility of some weight regain, especially if lifestyle improvements have not been made. Also, in a small number of people, heartburn, belching or reflux could be a problem after the sleeve, whereas the Band usually improves this.
Disadvantages of the Sleeve include a higher risk of complications, reflux, and uncertainty in its stretching in the long term, which could lead to some weight regain.
An advantage of the Sleeve over the Band is that is does not require adjusting. This means clinic appointments after the surgery can be less frequent- once every 3 months rather than once a month. This may make the Sleeve more suitable if you live outside of Sydney, or foresee difficulties in getting back to the clinic. Another advantage is that there are fewer dietary restrictions with the Sleeve- most types of food can continue to be eaten, just in smaller quantities. Although people with a Band often find steak and white bread difficult, the vast majority of foods can still be comfortably eaten provided everything is chewed well and eaten slowly.
Although the sleeve requires less aftercare, on-going medical, dietary and psychological support remains just as important.
Because the Sleeve restricts soft and liquid calories better than a Band, the Sleeve usually results in a more consistent reduction in calorie intake overall. This means that the average amount of weight loss after a Sleeve is usually a little bit better than for a Band – our average weight loss after a Sleeve is 76% of excess weight, vs. 62% after a Band. (The “excess weight” is the number of kilograms you are carrying over the ideal body mass index of 25). Having said that, averages don’t necessarily tell the full story – some of our more successful Band patients have lost ALL of their excess weight and more. For those that struggle with a band, it almost always has to do with continued consumption of too many soft and liquid calories, especially chocolate and milkshakes, and missing clinic appointments. The Band requires more discipline from a patient for it to work.
Weight loss after a Sleeve is slightly greater than a Band for the average patient; however, more motivated patients can do just as well with a Band. It’s more dependent on how it is used.
Regardless of their differences, both the Band and the Sleeve are far more effective than diets and exercises alone for people with a long-term weight problem. On-going participation in multi-disciplinary follow-up after surgery, and a commitment toward lifestyle improvement remain the most important factors.