The Lap Band and the Gastric Sleeve are two distinct types of bariatric surgery used to treat severe obesity. Both procedures promote weight loss by reducing the stomach’s capacity, but they use fundamentally different surgical techniques. The Lap Band (laparoscopic adjustable gastric banding) involves placing an adjustable device around the stomach. The Gastric Sleeve (sleeve gastrectomy) permanently alters the stomach’s anatomy by removing a large portion of it. Understanding these differences is crucial for exploring surgical options.
The Lap Band Procedure Explained
The Lap Band procedure is purely restrictive, limiting the amount of food a person can consume at one time. This minimally invasive technique involves placing an inflatable silicone ring around the upper portion of the stomach. The ring is cinched to create a small pouch above the band and a much larger section of the stomach below it.
The device is connected to a port beneath the skin, allowing the surgeon to inject or remove saline solution to control the band’s tightness. Because the upper pouch is small, patients feel full after eating a small quantity of food, reducing overall calorie intake. The procedure does not involve any cutting, stapling, or removal of stomach tissue, distinguishing it from other bariatric operations.
The Gastric Sleeve Procedure Explained
The Gastric Sleeve procedure (sleeve gastrectomy) is a permanent surgical alteration performed using laparoscopic techniques. During the operation, a surgeon removes approximately 75 to 80% of the stomach vertically. The remaining stomach is reshaped into a narrow, tube-like structure, or “sleeve,” connecting the esophagus to the small intestine.
This procedure works through a dual mechanism: restriction and hormonal change. The smaller stomach capacity restricts food intake, but the removal of the fundus—the dome-shaped upper part of the stomach—has a profound metabolic effect. The fundus is the primary site of ghrelin production, a hormone that stimulates appetite, so its removal significantly reduces hunger signals. This hormonal change contributes to the greater and more sustained weight loss achieved with the Gastric Sleeve.
Comparing Weight Loss Results and Recovery Time
The magnitude of weight loss and the speed of recovery differ significantly between the two procedures. Gastric Sleeve patients typically experience a more substantial reduction in excess weight, averaging 65% to 70% of excess weight loss (EWL) within the first 12 to 18 months. This rapid loss is attributed to the combined effect of physical restriction and reduced appetite from hormonal changes.
In contrast, the Lap Band generally results in less overall weight loss, averaging 40% to 50% EWL over a two-year period. The long-term success rate for maintaining weight loss is lower for the Lap Band, and it carries a higher risk of needing re-operation or conversion over time. Recovery time also differs: Lap Band surgery is often outpatient, allowing a return to normal activities within about one week. Sleeve gastrectomy usually requires a hospital stay of one to two nights, with a return to full activity taking closer to two weeks due to internal healing.
Reversibility, Adjustability, and Permanence
The fundamental difference between the Lap Band and the Gastric Sleeve lies in their permanence and capacity for modification. The Lap Band is the only major bariatric procedure considered fully reversible. Since the band is a device placed around an intact stomach, it can be surgically removed, allowing the stomach to return to its original size.
The band is also highly adjustable; a surgeon can tighten or loosen the restriction by adding or removing saline solution through the access port. Conversely, the Gastric Sleeve is a permanent and non-reversible surgery because the majority of the stomach is physically removed. Once the 75-80% portion of the stomach is detached, the anatomical change is final.