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Roux-en-Y gastric bypass may be superior to gastric banding for weight loss, correction of comorbidities among morbidly obese
Romy S. Arch Surg. 2012;doi:10.1001/archsurg.2011.1708.
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Compared with gastric banding, roux-en-Y gastric bypass was associated with improved weight loss and superior correction of some comorbidities among morbidly obese patients. The early complication rate was higher for bypass, but researchers said this is compensated largely by the higher, long-term complication and reoperation rates seen with gastric banding.
"The prevalence of morbid obesity has been growing exponentially over the past 20 years," Michel Suter, MD, of the Department of Surgery at Hospital du Chablais, Aigle-Monthey in Switzerland, and colleagues wrote. "A recent survey showed that bariatric procedures have more than doubled between 2003 and 2008. In the United States, the increase was much greater for gastric banding than for gastric bypass."
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Despite gastric banding's popularity, the researchers hypothesized that roux-en-Y gastric bypass provides superior results. To test their hypothesis, they performed a matched-pair study of 442 patients with a BMI of less than 50. Patients were matched based on age, sex and BMI, and interventions included laparoscopic gastric banding or roux-en-Y gastric bypass. The primary outcomes were operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile and long-term morbidity.
Follow-up was 92.3% 6 years after surgery. Significantly more early complications occurred after roux-en-Y gastric bypass (17.2%) vs. gastric banding (5.4%; P< .001). However, most were not life-threatening and were treated conservatively, the researchers wrote.
Maximal weight loss occurred after a mean 36 months in the banding group vs. 18 months in the gastric bypass group (P< .01). Additionally, in the bypass group, maximal excess weight loss was significantly higher (78.5% vs. 64.8%; P< .001), and the mean nadir BMI was lower (26.7 vs. 29.4; P< .001).
More failures � defined as a BMI of more than 35 or reversal of procedure/conversion � occurred in the banding group at 6 years vs. bypass (48.3% vs. 12.3%; P< .001). In addition, compared with bypass surgery, banding was associated with more long-term complications (19% vs. 41.6%; P< .001) and more reoperations (12.7% vs. 26.7%; P< .001).
According to Jacques Himpens, MD, of the European School of Laparoscopy at Saint Pierre University Hospital in Brussels, Belgium, and author of an accompanying editorial, roux-en-Y gastric bypass is a better bariatric procedure compared with gastric banding, but caveats remain.
Among these, Himpens said, "A well-performed gastric banding is better than a poorly executed roux-en-Y gastric bypass," and the limited influence gastric banding has on incretins and other gastrointestinal hormones could be advantageous in the long-term.
"Notwithstanding these words of caution, Suter et al must be commended for their scientific rigor and zealous follow-up," he wrote. "Both constitute an enlightening example for all of us bariatric surgeons."
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