Advanced Mediterranean Diet Blog

Nonsurgical approaches to relieve morbid obesity, such as drug therapy, low-calorie diets, exercise, and behavior modification have been disappointing.

Bariatric surgery for morbid obesity, on the other hand, has been effective more often and to a greater degree.  Hence, the ten-fold increase in bariatric procedures over the past decade.

The leading procedures these days are Roux-en-Y gastric bypass and laparascopic adjustable gastric banding.  Banding is being promoted as safer and potentially reversible compared to the time-honored gastric bypass.

Doctors in the Department of Medicine at the University of California, San Francisco, recently reviewed the scientific literature that compares the two procedures.  They found 14 comparative studies done between 2000 and 2007.  The studies followed patients for at least one year after surgery, monitoring for complications, amount of weight loss, adverse events, quality of life, and effects on obesity-related medical conditions.

Findings

• Loss of excess body weight (measured at one year) was greater for gastric bypass than for banding: average difference was 26%.  In other words, bypass patients lost 26% more weight.
• Bypass patients had greater resolution of obesity-related medical conditions: diabetes, high blood pressure, adverse cholesterol levels, and sleep apnea.
• Length of hospitalization and operating room time were shorter for gastric banding.
• Death rates were under 0.5% for both procedures.
• Complications around the time of surgery were higher for bypass than for banding - 9% versus 5%.
• Long-term need for additional related operations was lower after gastric bypass - 16% versus 24%.
• Patient satisfaction was greater for gastric bypass.

Discussion From the Study Authors

Previous research has shown that weight loss improves both social functioning and quality of life.  Carefully controlled studies have demonstrated between 25% and 60% reductions in all-cause, cardiovascular, and cancer mortality associated with significant weight loss.

There is a risk that commercial sponsorship of laparoscopic adjustable gastric banding may promote the use of these devices over Roux-en-Y gastric bypass, which has no commercial sponsor.

Until trials demonstrate the advantages of laparoscopic adjustable gastric banding in clearly defined subgroups of patients, Roux-en-Y gastric bypass should remain the bariatric procedure of choice in the United States.

My Comment

You can bet there will be heated debate about this study in the bariatric surgery community, with vigorous rebuttals from people heavily invested in the banding devices.  Even if you have no dog in the fight, you can still disagree with these results.  But have your facts ready.

Steve Parker, M.D.

Reference:  Tice, Jeffrey, et al.  Gastric Banding or Bypass?  A Systematic Review Comparing the Two Most Popular Bariatric Procedures.  American Journal of Medicine, 121 (2008):885-893.

This entry was posted on Tuesday, November 4th, 2008 at 11:13 am and is filed under Bariatric Surgery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.