Expert: John Pilcher, MD - 1/31/2008

Question
I'm 5'-8" 270lb, Type ll diabetic for ~ 2years now. I take medication for blood pressure, cholesterol, 3 oral for diabetes plus insulin, and use a CPAP machine. I've struggled with weight most of my life. When I approached my pcp about lap band he felt it was a very good choice. After visiting the surgeon he thought RNY would be a better choice, mostly due to the diabetes. My pcp agrees. No insurance, all out of pocket $20k. Now I'm starting to second guess surgery at all, but bottom line is I don't think I have an alternative other than further health implications. Just not sure how to proceed at this point. Any input?

Answer
Gene,
The medical data indicates that the rate of full remission of diabetes is about 85% for gastric bypass and about 60% for Band.  In the case of gastric bypass, there are some hormone changes that occur that cause a rapid improvement in the diabetes.  Altogether, most bariatric surgeons agree that gastric bypass is somewhat preferred in patients who suffer from diabetes.

It's a real shame you don't have insurance coverage.  The gastric bypass is a bit more expensive on the front end, but when you look at the costs you have to consider the cost of Band adjustments as well.

Best of luck to you!
Dr JP