Is weight loss more successful after gastric bypass than gastric banding for obese patients?

Centre for Obesity Research and Education, Monash University, Melbourne, Australia.
Nature Clinical Practice Gastroenterology &#38 Hepatology (Impact Factor: 5.33). 03/2009; 6(3):136-7. DOI: 10.1038/ncpgasthep1363
Source: PubMed

ABSTRACT Several studies have demonstrated that the short-term weight loss achieved by Roux-en-Y gastric bypass is greater than that achieved by laparoscopic adjustable gastric banding. This notion is supported by Puzziferri et al., who compared the weight loss that these two techniques achieved during the first 2 years after surgery. The real need in this field, however, is for long-term data with >10 years of follow-up, or in the absence of such data, medium-term data with 3-8 years follow-up. The aim of obesity therapy is to achieve sustainable weight loss, yet the published literature on bariatric surgery is dominated by the presence of short-term data. To convince a skeptical community of the value of bariatric surgery, data that reports the medium-to-long-term outcomes of these approaches must be presented with complete follow-up of all patients, or with sufficient statistical power to allow for those lost to follow-up. Only then can a relevant comparison of various bariatric procedures be conducted.

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    ABSTRACT: Background For over a decade, the Laparoscopic Adjustable Gastric Band (LAGB) was one of the most performed bariatric procedures in Europe. This study is a retrospective analysis with prospectively collected data of the experience in one specialized Dutch centre with the Adjustable Gastric Band over 14 years. Setting General Hospital specialized in Bariatric Surgery, The Netherlands Europe. Patients and methods Between 1995 and 2003, 201 patients underwent a LAGB for morbid obesity in our hospital. Data on preoperative clinical characteristic, postoperative outcome and weight-loss patterns and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System (BAROS). Results Average follow-up was 13.6 (±2.0) years (163 months) and 99% of patients with complete follow-up. Two-thirds of patients reached an Excess Weight Loss (EWL) >50% at some point after LAGB placement. However, due to insufficient weight loss or complications in 53% of patients, the LAGB had to be removed or converted to a Roux-en-Y Gastric Bypass. Additionally, half the remaining patients had disappointing results according to the BAROS score. In total, less than one quarter (22%) of patients had a functioning band with a good result after the follow-up period. Although initially the number of patients experiencing co-morbidities was reduced, most of them returned and a large number of patients developed new co-morbidities. Complications, other than weight regain, were numerous as 47% of patients experienced at least one. In total 204 re-operations were performed in 137 (68%) patients. Furthermore, patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up. Conclusion Morbid obesity is a chronic disease that can be resolved with bariatric surgery. One of the treatment options is the LAGB, which in the short term shows good results in terms of EWL and co-morbidity reduction. In the long term, however, EWL and co-morbidity reduction are disappointing and the LAGB does not seem to live up to expectations. Besides the decrease in EWL over time, the number of reoperations required is alarming. In total, less than a quarter of patients still had a functioning band after a mean 14 years of follow-up.
    Surgery for Obesity and Related Diseases 07/2014; 10(4). DOI:10.1016/j.soard.2014.03.019 · 4.94 Impact Factor
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    ABSTRACT: Before bariatric surgery, some patients with type 2 diabetes mellitus (T2DM) experience improvement in blood glucose control and reduced insulin requirements while on a preoperative low-calorie diet (LCD). We hypothesized that patients who exhibit a significant glycemic response to this diet are more likely to experience remission of their diabetes in the postoperative period. Insulin-dependent T2DM patients undergoing bariatric surgery between August 2006 and February 2011 were eligible for inclusion. Insulin requirements at day 0 and 10 of the LCD were compared. Patients with a ≥50% reduction in total insulin dosage to maintain appropriate blood glucose control were considered rapid responders to the preoperative LCD. All others were non-rapid responders. We analyzed T2DM remission rates up to 1 y postoperatively. A total of 51 patients met inclusion criteria and 29 were categorized as rapid responders (57%). The remaining 22 were considered non-rapid responders (43%). The two groups did not differ demographically. Rapid responders had greater T2DM remission rates at 6 (44% versus 13.6%; P = 0.02) and 12 mo (72.7% versus 5.9%; P < 0.01). In patients undergoing laparoscopic gastric bypass, rapid responders showed greater excess weight loss at 3 mo (40.1% versus 28.2%; P < 0.01), 6 mo (55.2% versus 40.2%; P < 0.01), and 12 mo (67.7% versus 47.3%; P < 0.01). Insulin-dependent T2DM bariatric surgery patients who display a rapid glycemic response to the preoperative LCD are more likely to experience early remission of T2DM postoperatively and greater weight loss.
    Journal of Surgical Research 06/2013; DOI:10.1016/j.jss.2013.06.014 · 2.12 Impact Factor
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    ABSTRACT: Studies have reported significant improvement of obstructive sleep apnea (OSA) in obese patients after bariatric surgery (BS). Weight loss following BS is rapid in the first few months, but it can take at least 1 year to reach the final result. The aim of this study is to measure the effect of BS on various clinical, respiratory, and sleep parameters of OSA at two postoperative intervals. Prospectively, all patients being evaluated for BS underwent a polysomnography (PSG). Patients diagnosed with OSA preoperatively were invited to undergo a PSG at least 6 months postoperatively and if OSA persisted, again at least 12 months postoperatively. One hundred ten patients underwent a first postoperative PSG 7.7 months after surgery. The mean apnea-hypopnea index (AHI) significantly decreased from 39.5 to 15.6/h. In 58.2 %, the AHI was reduced to below 10 and in 25.5 % to below 5. Fifty patients underwent a first PSG 7.1 months and a second PSG 16.9 months after surgery. The mean AHI decreased from 49.1 to 22.7 to 17.4/h following BS. BS initiates dramatic improvement and even remission of clinical and sleep parameters during the first 7 months, which continues at a slower rate over the next 10 months. We recommend a follow-up PSG after surgery to check for residual disease and if necessary retritration of continuous positive airway pressure, which may lead to higher treatment compliance.
    Obesity Surgery 07/2013; 24(1). DOI:10.1007/s11695-013-1023-y · 3.74 Impact Factor


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