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Gastric bypass yielded better long-term results than gastric band
Compared with gastric banding, gastric bypass surgery has better outcomes for long-term weight loss, controlling type 2 diabetes and high blood pressure and lowering cholesterol levels, according to recent study findings published in JAMA.
“We know gastric bypass brings more weight-loss success and relief of commonly associated illness vs. gastric band at 1 year after surgery,” Nancy Puzziferri, MD, MS, assistant professor of surgery at the University of Texas Southwestern Medical Center in Dallas, said in a press release. “We now have the best evidence available telling us this outcome continues to be true, even up to 5 years after surgery. We also know these procedures maintain their safety profile long term.”
Puzziferri and colleagues conducted a clinical review of 29 studies describing outcomes for gastric bypass, gastric band or sleeve gastrectomy performed on patients with a BMI ≥35 to determine the effectiveness of each treatment type 2 years after the procedure for weight loss, type 2 diabetes, hypertension and hyperlipidemia.
Inclusion criteria for weight-loss outcomes was met by 11 gastric bypass studies, 13 gastric band studies and two sleeve gastrectomy studies. Greater weight loss was achieved with gastric bypass (sample-size-weighted mean excess weight loss, 65.7%) vs. gastric band (45%).
Inclusion criteria for type 2 diabetes after bariatric surgery was met by six studies; all reported remission rates of HbA1c <6.5% without medication. Type 2 diabetes sample-size-weighted remission rates were greater after gastric bypass (66.7%) vs. gastric band (28.6%). The decrease in sample-size-weight mean HbA1c was also greater after gastric bypass (2.2%) vs. gastric band (1.5%).
Gastric bypass led to greater remission rates for hypertension (38.2%) vs. after gastric band (17.4%). Remission rates for hyperlipidemia were also greater after gastric bypass (60.4%) vs. gastric band (22.7%).
“Studies of bariatric surgery long-term outcomes demonstrate substantial and sustained weight loss for gastric bypass procedures exceeding that for gastric band,” the researchers wrote. “There are few long-term studies with similar reliable follow-up for gastric sleeve operations. Flawed study design and incomplete assessment and reporting limit conclusions being drawn from most studies that had reasonable follow-up. To fully characterize the efficacy of bariatric surgery, long-term outcomes studies should report results for at least 80% of initial cohorts with follow-up exceeding 2 years.”
Disclosure: The study was funded in part by the Department of Surgery of the University of Texas Southwestern Medical Center, Dallas, and the National Center for Advancing Translational Science at the NIH.