Article

Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures

Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-1732, USA.
The American journal of medicine (Impact Factor: 5.3). 11/2008; 121(10):885-93. DOI: 10.1016/j.amjmed.2008.05.036
Source: PubMed

ABSTRACT Bariatric surgical procedures have increased exponentially in the United States. Laparoscopic adjustable gastric banding is now promoted as a safer, potentially reversible and effective alternative to Roux-en-Y gastric bypass, the current standard of care. This study evaluated the balance of patient-oriented clinical outcomes for laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass.
The MEDLINE database (1966 to January 2007), Cochrane clinical trials database, Cochrane reviews database, and Database of Abstracts of Reviews of Effects were searched using the key terms gastroplasty, gastric bypass, laparoscopy, Swedish band, and gastric banding. Studies with at least 1 year of follow-up that directly compared laparoscopic adjustable gastric banding with Roux-en-Y gastric bypass were included. Resolution of obesity-related comorbidities, percentage of excess body weight loss, quality of life, perioperative complications, and long-term adverse events were the abstracted outcomes.
The search identified 14 comparative studies (1 randomized trial). Few studies reported outcomes beyond 1 year. Excess body weight loss at 1 year was consistently greater for Roux-en-Y gastric bypass than laparoscopic adjustable gastric banding (median difference, 26%; range, 19%-34%; P < .001). Resolution of comorbidities was greater after Roux-en-Y gastric bypass. In the highest-quality study, excess body weight loss was 76% with Roux-en-Y gastric bypass versus 48% with laparoscopic adjustable gastric banding, and diabetes resolved in 78% versus 50% of cases, respectively. Both operating room time and length of hospitalization were shorter for those undergoing laparoscopic adjustable gastric banding. Adverse events were inconsistently reported. Operative mortality was less than 0.5% for both procedures. Perioperative complications were more common with Roux-en-Y gastric bypass (9% vs 5%), whereas long-term reoperation rates were lower after Roux-en-Y gastric bypass (16% vs 24%). Patient satisfaction favored Roux-en-Y gastric bypass (P=.006).
Weight loss outcomes strongly favored Roux-en-Y gastric bypass over laparoscopic adjustable gastric banding. Patients treated with laparoscopic adjustable gastric banding had lower short-term morbidity than those treated with Roux-en-Y gastric bypass, but reoperation rates were higher among patients who received laparoscopic adjustable gastric banding. Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States.

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    • "After diet alone, 75% of patients regain most of their weight [9] and the addition of behavioural treatments only modestly improves the results [10]. Bariatric surgery is currently the only treatment achieving a sufficient and durable weight loss [11] [12]; still, follow-up studies show that a number of patients present a weight regain as early as 1 to 2 years after surgery [13] [14]. One of the major reasons for the treatments' ineffectiveness is the large prevalence of eating disorders in obese patients trying to lose weight [15], namely, binge eating disorder (BED) [16]. "
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    ABSTRACT: Objective. The aim of this study is to analyse associations between eating behaviour and psychological dysfunctions in treatment-seeking obese patients and identify parameters for the development of diagnostic tools with regard to eating and psychological disorders. Design and Methods. Cross-sectional data were analysed from 138 obese women. Bulimic Investigatory Test of Edinburgh and Eating Disorder Inventory-2 assessed eating behaviours. Beck Depression Inventory II, Spielberger State-Trait Anxiety Inventory, form Y, Rathus Assertiveness Schedule, and Marks and Mathews Fear Questionnaire assessed psychological profile. Results. 61% of patients showed moderate or major depressive symptoms and 77% showed symptoms of anxiety. Half of the participants presented with a low degree of assertiveness. No correlation was found between psychological profile and age or anthropometric measurements. The prevalence and severity of depression, anxiety, and assertiveness increased with the degree of eating disorders. The feeling of ineffectiveness explained a large degree of score variance. It explained 30 to 50% of the variability of assertiveness, phobias, anxiety, and depression. Conclusion. Psychological dysfunctions had a high prevalence and their severity is correlated with degree of eating disorders. The feeling of ineffectiveness constitutes the major predictor of the psychological profile and could open new ways to develop screening tools.
    International Journal of Endocrinology 03/2014; 2014:356289. DOI:10.1155/2014/356289
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    • "Currently, bariatric surgery is the only effective treatment for morbid obesity [1] [2] [3]. In recent years, laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) have been the 2 most common bariatric operations performed worldwide [4]. Since its appearance, LAGB has gained popularity among surgeons and patients by virtue of its indisputable advantages, including reversibility and minimal invasiveness with reduced surgical trauma to the gastrointestinal tract, adjustability by patient weight, and very low mortality associated with durable and appropriate weight loss [5]. "
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    ABSTRACT: Background Despite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20-60 % of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic gastric sleeve (LGS). Methods The bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LGS, from November 2007 to June 2012. Results A total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All the procedures were performed in two-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1 ± 17.9 months while for the LGS patients was 24.2 ± 14.3months. The mean body mass index (BMI) prior LRYGB and LGS was 45.6 ± 7.8 and 47.5 ± 5.6 (p=0.09), respectively. Post-operative complications occurred in 16.2 % of the LRYGB patients and in 2.9 % of the LGS group (p=0.04). Mean %EWL was 59.9% ± 16.2% and 70.2% ± 16.7% in LRYGB, and it was 52.2% ± 11.4% and 59.9% ± 14.4% in LSG at 12 months (p=0.007) and 24 months (p=0.01) after conversion. Conclusions In this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity.
    Surgery for Obesity and Related Diseases 03/2014; 10(6). DOI:10.1016/j.soard.2014.03.017
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    • "In the highestquality study, excess body weight loss at 1 year after LAGB is 48%. At this time the hypertension, diabetes, dyslipidemia, and sleep apnea resolution rate were about 55%, 58%, 42%, and 45%, respectively [5]. Weber et al. reported an EWL of 42.1% at 24 months with a hypertension, diabetes, and dyslipidemia resolution rate of 70%, 60% and 0%, respectively . "
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    ABSTRACT: Metabolic syndrome is strictly associated with morbid obesity and leads to an increased risk of cardiovascular diseases and related mortality. Bariatric surgery is considered an effective option for the management of these patients. We searched MEDLINE, Current Contents, and the Cochrane Library for papers published on bariatric surgery outcomes in English from 1 January 1990 to 20 July 2012. We reported the effect of gastrointestinal manipulation on metabolic syndrome after bariatric surgery. Bariatric surgery determines an important resolution rate of major obesity-related comorbidities. Roux-en-Y gastric bypass and biliopancreatic diversion appear to be more effective than adjustable gastric banding in terms of weight loss and comorbidities resolution. However, the results obtained in terms of weight loss and resolution of comorbidities after a "new bariatric procedure" (sleeve gastrectomy) encouraged and stimulated the diffusion of this operation.
    Gastroenterology Research and Practice 10/2012; 10(2012). DOI:10.1155/2012/670418
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