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). 11/2008; 121(10):885-93. DOI: 10.1016/j.amjmed.2008.05.036
Source: PubMed


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.

    • "The Roux-en-Y gastric bypass (RYGB) is the most common and the standard of care for surgical treatment of obesity.[13] The majority of weight loss has been shown to occur within the first 12-18 months through restricted intake, and/or malabsorption.[14] "
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    ABSTRACT: Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.
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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.
    Full-text · Article · Mar 2014 · International Journal of Endocrinology
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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.
    Full-text · Article · Mar 2014 · Surgery for Obesity and Related Diseases
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