July 2006 : Extremely obese patients who undergo gastric bypass procedures may have fewer complications, a greater reduction in obesity-related diseases, more weight loss and a higher level of satisfaction than those who have gastric banding procedures, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.
Obesity is increasingly prevalent in the United States, with some individuals reaching super morbid obesity, or having a body mass index (BMI) greater than 50, according to background information in the article. The weight of super morbidly obese patients has been described as being equal to or greater than 225 percent of their ideal body weight. Conditions associated with obesity in these patients, including hypertension (high blood pressure), diabetes, sleep apnea and arthritis, raise their risk for complications following bariatric (weight loss) surgery.
Wilbur B. Bowne, M.D., and colleagues at The State University of New York, Health Science Center of Brooklyn, and Lutheran Medical Center, Brooklyn, compared the outcomes among super morbidly obese patients following two commonly performed types of bariatric surgery. Laparoscopic Roux-en-Y gastric bypass involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions. In laparoscopic adjustable gastric banding, surgeons place a band-like device around the stomach, dividing the stomach into two smaller compartments. The researchers analyzed the records of 106 consecutive patients who had one of the two procedures at a single community teaching hospital between February 2001 and June 2004.
Of the 106 patients, 60 (57 percent, average age 41.9 years) had gastric banding procedures and 46 (43 percent, average age 42.8 years) underwent gastric bypass. Gastric bypass procedures took longer (121 vs. 75 minutes) and required longer hospital stays than gastric banding procedures (3.5 vs. 1.8 days). However, after 30 days, 78 percent of those who had gastric banding experienced complications, including dehydration and vomiting, compared with 28 percent of those who had gastric bypass surgery. Gastric banding patients also had more secondary operations (15 vs. three), less weight loss (a BMI decrease of 9.8 as compared with 26.5) and reported a lower rate of overall satisfaction with the procedure. Nearly 80 percent of gastric bypass patients said they were very satisfied and none were dissatisfied or regretted having had the procedure, while 46 percent of gastric banding patients were very satisfied, 35 percent were satisfied and 10 patients reported dissatisfaction or regret. One death was reported, in a gastric banding patient. All patients reported fewer comorbidities after surgery, but the decrease was more pronounced in gastric bypass patients--for example, rates of diabetes dropped from 17.4 to 0 percent in the gastric bypass group and 18.3 to 11 percent among gastric banding patients.
"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 write. "In our experience, laparoscopic Roux-en-Y gastric bypass appears superior to laparoscopic adjustable gastric banding in super morbidly obese patients." (Arch Surg. 2006;141:683-689. Available pre-embargo to the media at www.jamamedia.org.)
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Source: JAMA and Archives Journals
