For super morbidly obese patients, Roux-en-Y gastric bypass surgery is a better approach than gastric banding, according to researchers.. The body-mass index of those who underwent gastric bypass dropped by more than 26 points after about a year, compared with nearly 10 points for those who underwent gastric banding (P<.001), said George S. Ferzli, M.D., of the State University of New York Health Science Center in Brooklyn, and colleagues.
The bypass group also suffered fewer late complications, re-operations, and comorbidity after surgery, the researchers reported.
Super morbidly obese patients are those with a BMI greater than 50. These patients have higher rates of hypertension, diabetes, sleep apnea, and other comorbidities. However, most previous studies comparing gastric bypass with gastric banding have not focused on this patient group specifically, the researchers said.
The current study prospectively analyzed data from 106 super morbidly obese patients who underwent bariatric surgery at the center during 2001 to 2004. Their average age was about 42, and their average BMI was about 56. Of the 106 patients, 46 underwent laparoscopic bypass surgery and 60 underwent laparoscopic banding. Median follow-up was 16 months.
Dr. Ferzli performed all the procedures. The 106 super morbidly-obese patients represented about a third of the 315 who had such operations at SUNY Brooklyn during the study period.
From 30 days post-surgery to the end of the study period, 78% of the banding group suffered complications-most commonly dehydration and vomiting-compared with 28% of the bypass group (P<.05). However, complication outcomes were not significantly different between the two groups prior to 30 days.
Fifteen of the banding patients had to have another procedure, most often adjustment of the band, compared with three of the bypass patients (P<.04). One patient in the banding group died from aspiration pneumonia following elective band removal. No patients in the bypass group died.
About 18% of patients had diabetes. This figure fell to 0% for the bypass group compared with 11% for the banding group during follow-up (P=.05). Similarly, sleep apnea affected about half of patients, but the proportion fell to 8% in the bypass group versus 31% in the banding group (P=.01).
Gastric bypass took longer, however (121 minutes versus 75 minutes on average; P<.001), and required a longer hospital stay (3.5 days versus 1.8 days; P<.002).
Finally, nearly 80% of bypass patients said they were "very satisfied" with the procedure, compared with 46% of the banding patients (P<.006).
"Our study represents the first focused attempt to address the effectiveness of laparoscopic adjustable gastric banding compared with laparoscopic Roux-en-Y gastric bypass in super morbidly obese patients, in hopes of better defining potential benefits that may guide future treatment planning," the authors said.
While tentatively concluding that bypass "appears superior" to banding in the super morbidly obese, the authors noted that banding achieved "modest" weight loss and suggested the procedure be further evaluated in this patient population.
· Advise interested patients that this study suggests that gastric bypass results in more weight loss with fewer complications, greater reduction in comorbidity, and greater patient satisfaction than gastric banding in super morbidly obese patients.
Bowne W et al. "Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis." Arch Surg 2006; 141:683-689.
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