Study Compares 2 Common Weight-Loss Surgeries

Gastric banding, bypass each have their pluses and minuses, researchers say

By Robert Preidt

Thursday, October 30, 2014

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THURSDAY, Oct. 30, 2014 (HealthDay News) -- A comparison of two of the most common types of weight loss surgery found that laparoscopic gastric bypass helped patients shed more excess pounds than adjustable gastric banding, but carried a higher risk of short-term complications and long-term hospitalizations.

Gastric-bypass surgery makes the stomach smaller and reroutes the small intestine, so your body does not absorb all the calories from food you eat, according to the National Institutes of Health. Gastric banding is a type of weight-loss procedure in which an adjustable band is placed around the top of the stomach to create a small stomach pouch.

There is ongoing debate about the risks and benefits of the two types of weight loss surgery, and previous studies have yielded conflicting findings, according to the researchers. The study analyzed data from more than 5,800 patients in the United States who had laparoscopic gastric bypass and nearly 1,200 who had gastric banding.

Overall, patients who got the laparoscopic gastric bypass procedure lost almost twice the amount of weight as those who got the banding procedure, the study found.

However, there were more complications with bypass vs. banding. Within a month after surgery, 3 percent of gastric bypass patients had experienced one or more major complications, compared to 1.3 percent of gastric banding patients, the study found.

Longer-term follow-up found that in the gastric banding group, 0.2 percent of patients died, about 12 percent were hospitalized again, and about 14 percent had one or more subsequent interventions. In comparison, 0.3 percent of patients getting bypass died, about 20 percent faced rehospitalization, and 5.5 percent required another procedure.

"We found important differences in short- and long-term health outcomes for the [gastric banding] and [gastric bypass] procedures across 10 health care systems in the United States," wrote a team led by Dr. David Arterburn of Group Health Research Institute in Seattle. "Severely obese patients should be well informed of these differences when they make their decisions about treatment," they said.

The study was published online Oct. 29 in the journal JAMA Surgery.

The findings are important but may already be outdated, one expert said.

"Since the time this study commenced, there has been a large shift in procedure selection," said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City. "Although the article states that banding and bypass are the two most common procedures, that is no longer true -- bands have dropped in popularity."

"At their peak, they represented over 40% of all bariatric procedures," Roslin said. "Today, that number is less than 20%. The reason is less weight loss and a high rate of [later need for band] extraction, which approaches 5 percent per year."

And he said that a procedure called "vertical sleeve gastrectomy has surpassed gastric bypass as the most popular stapling procedure." Sleeve gastrectomy is a surgery that reduces the size of the stomach.

According to Roslin, "a major issue with great cumulative studies is that they take time to perform. By the time the information is reported, fields have continued to grow and, hopefully, advance."

Another expert said that it's important to match the right patient with the procedure that best suits him or her.

"The study confirms what those of us in the field have observed in our patient populations," said Dr. Collin Brathwaite, chief of the Division of Minimally Invasive and Bariatric Surgery at Winthrop-University Hospital in Mineola, N.Y.

"It should be noted, however, that previously reported reoperation and intervention rates are much higher than reported here," he added. "We have patients that have done extraordinarily well with gastric banding. The real challenge is selecting the right operation for the right patient to get the best outcome."

SOURCES: Mitchell Roslin, M.D., chief, obesity surgery, Lenox Hill Hospital, New York City; Collin Brathwaite, M.D., chairman, department of surgery, and chief, Division of Minimally Invasive and Bariatric Surgery, Winthrop-University Hospital, Mineola, N.Y.; JAMA Surgery, news release, Oct. 29, 2014

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