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17-01-2012 | Surgery | Article

Gastric bypass works ‘better’ than gastric band

Abstract

Free abstract

MedWire News: Gastric bypass produces "better weight loss" than gastric banding, but with a higher complication rate, say researchers.

The study, published in the Archives of Surgery, adds further information to the debate over bariatric surgery, from which the research team concludes that both procedures have pros and cons.

Sébastien Romy (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland) and colleagues conducted a case-matched study involving 442 patients; 221 gastric band (GB) patients were matched with the same number of roux-en-Y gastric bypass (RYGBP) patients for gender, age, and body mass index (BMI).

All the patients had either a BMI over 40 kg/m2, or over 35 kg/m2 with at least one comorbidity, and underwent surgery after conservative therapy had failed and a decision was reached by a multidisciplinary team.

There were significantly more early complications among the RYGBP group than there were among the GB group (17.2 vs 5.4%), but most of these required only conservative treatment. After 6 months, the complication rate was significantly higher after RYGBP than after GB (41.6 vs 19.0%), as was the rate of reoperation (26.7 vs 12.7%).

The majority of long-term complications with RYGBP were related to internal hernia (11.3%).

The long-term GB complications were mainly functional problems such as esophageal dilation (10.4%), reflux requiring daily high-dose proton-pump inhibitor therapy (6.8%), or severe food intolerance (6.3%).

Maximal weight loss was significantly higher among the RYGBP than GB patients, and this was achieved over a mean of 18 months after RYGBP rather than 36 months after GB. After 3 years, 22.3% of the available GB patients had a BMI over 35 kg/m2 (mean 40.1 kg/m2), compared with only 15.0 % after RYGBP (mean BMI 36.1 kg/m2).

Romy and team therefore conclude that "RYGBP provides better, more rapid, and more sustained weight loss, resulting in better correction of comorbidities than GB. The cost is higher early morbidity."

An invited critique by Jacques Himpens (Saint Pierre University Hospital, Brussels, Belgium) provided some reasons to be cautious when considering these conclusions: "First, case-control studies can suffer from bias when one treatment is sensed as better than the other ab initio… Second, the GB appears to be operator dependent with remarkably better results in some centers… Third, the limited (if any) influence of the GB on incretins and other gastrointestinal hormones might turn out to be an advantage in the long-term."

He adds that although GB is considered reversible, patients do poorly after a second procedure after band removal.

By Chloe McIvor

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