Gastric Bypass Surgery

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Gastric Bypass vs. Gastric Banding: What Research Says

The United States is seeing a rapid increase in the rate of obesity, with a large portion of the population considered overweight or obese. Severity of obesity can be placed in one of three categories (class 1, 2 and 3), as measured by a person's Body Mass Index (BMI); the prevalence of class 3 obesity, the most severe, approaches 8 percent in some populations in the United States. Defined as a BMI of 40 or above, class 3 obesity is associated with an increased risk for health problems such as diabetes, hypertension, high blood cholesterol, heart disease, osteoarthritis, sleep apnea, and gallbladder disease. Perhaps not surprisingly, class 3 obesity is also associated with premature death.

Although significant weight loss leads to improved social functioning and quality of life, it is not easy for most people to achieve. There are many weight loss strategies available, including medications, low-calorie diets, exercise, behavioral modification, and surgery. However, many people don't find lasting success with most of these methods. Dietary measures to reduce weight generally result in a weight loss of less than 15%, with loss lessening to zero after 5 years [1]. Medication and behavioral therapy also result in only a small weight loss, with an average long-term loss of 7kg or fewer. These interventions don't appear to help reduce obesity-related medical complications, nor do they result in significant weight loss.

With few reliably effective approaches for treating morbid obesity, bariatric surgery options have been developed to induce significant weight loss. These procedures have been found to be much more effective in treating morbid obesity than most other current options, with an average weight loss of about 40 kg and improvement or resolution of many obesity-related health complications [2]. In fact, the National Institutes on Health currently recommend that people with a BMI of more than 40 or people with serious medical problems and a BMI of more than 35 consider bariatric surgery as a method of weight loss.

The most frequently performed bariatric surgery procedures are Roux-en-Y gastric bypass, the most common procedure in the United States, and laparoscopic adjustable gastric banding, predominant in Australia and Europe. Primarily restrictive procedures, gastric bypass and banding work by surgically limiting food intake. In Roux-en-Y gastric bypass surgery, a small stomach pouch is created and a portion of the stomach and small intestine is bypassed. In laparoscopic adjustable banding, an inflatable tube is placed around the stomach, just below the place where the esophagus and the stomach meet. Adding or removing a saline solution through a subcutaneous port allows the size of the outlet to be adjusted.

A recent review comparing these two most common gastric bypass procedures, conducted by Dr. Tice and his colleagues at the University of California, examined a number of studies to determine the advantages and disadvantages of each procedure [3]. The average patient in the studies they examined was about 40 years old and had a pre-surgery BMI of 45, placing them in the category of class 3 obesity. Eighty percent of the patients were female.

Advantages of Roux-en-Y Gastric Bypass

• Patients who received gastric bypass surgery consistently had better weight loss outcomes at one year post-surgery than those who underwent gastric banding, with a 25% difference found in favor of gastric bypass surgery. In the only randomized clinical trial available, only 4% (1 out of 24) of patients who received gastric bypass surgery failed to lose weight, compared to 35% (9 out of 26) of patients in the gastric banding group [4].
   
• A difference of 25% or greater was also found when examining the resolution of comorbidities, with gastric bypass patients more likely to be cured of obesity-related conditions after undergoing surgery. For example, in a study of patients with a BMI of 50 or greater, all patients with diabetes who received gastric bypass surgery were cured of the disease, compared to only 40% of the diabetic patients who received gastric banding [5].
   
• Fewer longer-term complications were seen in gastric bypass patients than in gastric banding patients.
   
• In the one study that reported patient satisfaction rates, 80% of patients who received gastric bypass surgery reported satisfaction with the procedure, compared to 46% of the patients in the gastric banding group [5].
   
• Reoperation rates for gastric bypass patients were slightly better than for gastric banding patients (12% versus 15%) [5].

Advantages of Laparoscopic Adjustable Gastric Banding

• In a comparison of short-term complication rates, results favored gastric banding.
   
• Although mortality was low for both types of bariatric surgery, there were fewer deaths among patients who received gastric banding surgery, which is generally considered less invasive and even potentially reversible.
   
• The length of the gastric banding surgical operation was shorter than the gastric bypass operation by approximately 68 minutes, and is generally a less-demanding surgery for doctors to perform.
   
• The average hospital stay was 2 days shorter for patients undergoing gastric banding procedures.

Conclusion

There are advantages to each bariatric surgery procedure, and both Roux-en-Y gastric bypass and laparoscopic gastric banding appear to be relatively safe procedures that often result in significant weight loss. However, the available data clearly shows that Roux-en-Y gastric bypass results in better weight loss outcomes overall. In general, gastric bypass seems to be more likely to cure patients of comorbidities such as sleep apnea, hypertension and diabetes, as well as provide patients with greater satisfaction regarding the procedure. It is also associated with fewer long-term complications. On the other hand, laparoscopic adjustable gastric banding is associated with fewer short-term complications, a quicker surgical procedure, and a shorter hospital stay.

Which type of bariatric surgery is best for you depends on a number of factors, including the country in which you plan to undergo the procedure, your particular health concerns and situation, and the expertise and recommendation of your doctor. At this time, Roux-en-Y gastric bypass surgery is the primary bariatric surgery procedure performed in the United States to treat obesity, and the results of scientific studies to date tend to indicate that it should remain as such.

References

1. Bennett W. Dietary treatments of obesity. Ann N Y Acad Sci. 1987; 499:250-263.

2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

3. Tice et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. The American Journal of Medicine. 2008;121.

4. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127-133.

5. Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683-689.

About the Author
Matt Papa, a research scientist at Washington University in St. Louis, MO, closely follows scientific literature related to the field of obesity treatment. Matt feels compassion for people who struggle with their weight, and enjoys discussing helpful scientific breakthroughs. In his website, Matt provides his own opinion on best diet programs for weight loss. He also offers Medifast diet coupon codes and a promotional discount for Nutrisystem, two clinically studied weight loss programs.