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 & Hepatology (Impact Factor: 5.33). 03/2009; 6(3):136-7. DOI: 10.1038/ncpgasthep1363
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: Bariatric surgery is an effective treatment for morbid obesity. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are commonly performed procedures. The aim of the present study was to evaluate and compare the long-term outcomes after LRYGB and LAGB. We studied the data from a prospective database of all patients undergoing LRYGB or LAGB with 5 years of follow-up. From July 2001 to September 2003, 91 and 62 patients underwent LRYGB and LAGB, respectively. Of these patients, 73.6% of the LRYGB and 91.9% of the LAGB patients had 5 years of follow-up. Of the 91 and 62 patients, 89% and 82% were women, respectively. The mean age and body mass index was 34.5 ± 11.0 years and 39.6 ± 4.9 kg/m(2) for the LRYGB group and 38.4 ± 13.1 years and 35.8 ± 4.0 kg/m(2) for the LAGB group, respectively. The mean operative time was 150 ± 58 minutes for LYRGB and 73 ± 23 minutes for LAGB (P <.05). The conversion and reoperation rate was 8% and 4.3%, respectively, for the LRYGB group versus 0% for the LAGB group. Early postoperative complications were observed in 12 and 1 patient (P = .014) after LRYGB and LAGB, respectively. Late complications developed in 33 and 17 patients after LYRGB and LAGB, respectively (P = NS). The percentage of excess weight loss at 5 years postoperatively was 92.9% ± 25.6% and 59.1% ± 46.8% (P <.001) for LRYGB and LAGB, respectively. Surgical failure (percentage of excess weight loss <50%) at 5 years was 6% for LRYGB and 45.6% for LAGB. A late reoperation was needed in 24.1% of the LAGB patients. A greater percentage of excess weight loss at 1 and 5 years was observed after LRYGB than LAGB. The LAGB group had a >40% rate of surgical failure and a 24.1% reoperation rate at 5 years of follow-up.
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ABSTRACT: Gastric bypass is a successful medical intervention for weight loss for obesity. Weight loss is substantial after this surgery. Predictors of the most successful weight loss are not yet fully known. The purpose of this study was to define variables that improve percent excess weight loss (%EWL) in this post-surgical population. All patients who underwent the Roux-en-Y gastric bypass (RYGB) during the 5 years preceding the study in one surgical practice (n = 805; respondents = 265; 33%) received the Arizona Activity Frequency Questionnaire and the Arizona Food Frequency Questionnaire. Analysis through ANOVA testing to determine relationships between selected behaviors and %EWL was performed. Comparisons of differences in mean %EWL were analyzed using the variables of energy consumption/day (energy consumption), hours of activity/day (hours in activity), and energy expended in activity/day (energy expended). Patients with more energy expended, and hours in activity demonstrated significantly better %EWL (p = 0.05) when compared to those with less energy expended or hours in activity. Reported energy consumption did not significantly influence %EWL in this study. This research suggests that in this sample of post-RYGB patients, energy expended in activity, as either energy expended or hours in activity improved their %EWL over those persons not expending as much energy in activity. Increasing the hours in activity improved the maintenance of %EWL in these respondents. Energy consumption did not have a statistically significant effect on %EWL or maintenance of %EWL in these subjects.
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ABSTRACT: Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes. A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%). After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5-7 years at approximately 15 kg/m(2) for the LRYGB patients and at about 9 kg/m(2) for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group. Over the long term, LRYGB had an approximate reduction of 15 kg/m(2) BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.