By Dr Ananya Mandal, MD
A new study evaluates the best option in terms of weight loss surgery for those who need it. Researchers found gastric bypass patients lose more weight than gastric banding patients and keep it off longer. Even though banding is a simpler operation, nearly half of those patients were still obese after six years.
Many doctors aren't surprised by those results. The study also determined patients who have gastric bypass surgery have a greater risk of deadly complication compared to banding. Researchers think the benefits outweigh the risks.
A gastric bypass operation called Roux-en-Y involves reducing stomach size with staples and connecting the smaller “pouch” directly to the small intestine. It is irreversible. Gastric banding, as its name implies, involves placing a band around part of the stomach to reduce its size. This procedure is reversible, the researchers noted. Dr. Mitchell Roslin, Head of Obesity Surgery, Lenox Hill Hospital said, “When we actually remove part of the stomach we change the hormones that control hunger and fullness and we change people's relationship with food.” “Both gastric banding and gastric bypass are currently performed for morbid obesity,” said Suter. “Bypass is more effective in terms of directs results such as weight loss, but a bit more dangerous immediately than banding,” he said.
However, banding often leads to long-term complications requiring some sort of major re-operation, Suter said. “In addition, many bands are not going to stay in place for much more than 10 years; hence, banding is unlikely to be the only weight-loss procedure the patient will be submitted to,” he said. “Patients should make a choice knowing this, and decide whether they accept a slightly higher early risk to improve their results, or if they want the least invasive procedure, but then accept a high risk of further surgery at a later time.”
The report was published in the Jan. 16 online edition of the Archives of Surgery. For the study, Suter's team followed for six years 442 patients who had either gastric bypass surgery or banding.
Although there were more early surgical complications among those who had Roux-en-Y surgery, these patients lost more weight faster than those who had gastric banding, the researchers found. After bypass surgery, about 17 percent of the patients had complications, compared with more than 5 percent of those who underwent banding, the researchers noted. But at six years there were more problems with gastric banding, including about 48 percent who had weight gain or the procedure reversed, compared with about 12 percent who had bypass surgery, the study found.
Gastric banding was associated with more long-term complications (more than 42 percent versus 19 percent) and more new procedures than bypass surgery (about 27 percent vs. 13 percent). Cholesterol levels among those who had gastric bypass surgery were consistently lower than among those who had gastric banding, who saw no change over time, the researchers add. This finding implies that blood sugar levels were also lower among those who underwent gastric bypass surgery, the study authors said.
“The prevalence of morbid obesity has been growing exponentially over the past 20 years,” the researchers wrote. “A recent survey showed that bariatric procedures have more than doubled between 2003 and 2008. In the United States, the increase was much greater for gastric banding than for gastric bypass.”