A new study has found that Roux-en-Y gastric bypass (RYGBP) for bariatric procedures offers more sustainable and rapid weight loss than gastric banding (GB).

Researchers at Centre Hospitalier Universitaire Vaudois (CHUV; Lausanne, Switzerland) conducted a matched-pair study involving 442 patients with a body mass index (BMI) lower than 50 that were matched according to sex, age, and BMI. The surgical procedures, laparoscopic GB or RYGBP, were performed by a common bariatric surgeon. The main outcome measures were operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity, as evaluated at six years postoperatively.

The results showed that early morbidity was higher after RYGBP (17.2%) than after GB (5.4%), but major morbidity was similar; comorbidities improved more after RYGBP. Weight loss was quicker, maximal weight loss was greater, and weight loss remained significantly better after RYGBP until the sixth postoperative year. At six years, there were more failures--reflected by a BMI higher than 35 or reversal of the procedure--after GB (48.3%) than RYGBP (12.3%). There were also more long-term complications and more reoperations after GB. The study was published early online on January 16, 2012, in Archives of Surgery.

“At the present time, Roux-en-Y gastric bypass seems clearly superior to gastric banding when treating morbidly obese patients, who should be informed accordingly,” concluded lead author Sebastien Romy, MD, and colleagues of the division of endocrinology, diabetology, and metabolism. “The higher early complication rate […] is largely compensated by the much higher long-term complication and reoperation rates seen after gastric banding.”

Bariatric surgery is achieved by reducing the size of the stomach with an implanted medical device (GB), through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and rerouting the small intestines to a small stomach pouch (RYGBP). Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality. In the United States, there is a much greater increase in GB than RYGBP, probably due to the preconception that GB is a "simpler and safer" procedure.

 

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