A new study recommends that gastric banding be forsaken in favor of sleeve gastrectomy or Roux-en-Y gastric bypass procedures.

Researchers at the University of Naples Federico II (Italy) presented 10-year follow-up data from a prospective randomized trial involved 51 patients who were randomized from January to November 2000 to either laparoscopic adjustable gastric banding or laparoscopic Roux-en-Y gastric bypass. In the banding group, mean age was 33.3 years and mean body mass index (BMI) was 43.4 kg/m²; in the bypass group, mean age was 34.7 years and mean BMI was 43.8 kg/m².

The 10-year follow-up results showed that 81.4% of the banding group and 87.5% of the bypass group remained in follow-up; of the 22 remaining banding patients, 9 (41%) had had their bands removed, leaving 13 for weight-loss evaluation. The BMI of 6 of these 13 patients exceeded 35 kg/m²; only 7 patients in the banding group were successful in losing weight. In contrast, of the remaining 21 bypass patients, mean BMI dropped from 43.8 to 30.4 kg/m²; only 20% of the procedures in this group were considered failures. The study was presented at the American Society for Metabolic and Bariatric Surgery 29th annual meeting, held during June 2012 in San Diego (CA, USA).

“There is no point in doing further study comparing bypass with banding at this point,” said lead author and study presenter Luigi Angrisani, MD. “If you consider the revisions and the failures, only 26% of the banding patients had the band successfully implanted and a successful weight loss.”

Gastric banding is a surgical procedure to reduce the size of the stomach for weight loss. A silicone band is placed around the upper portion of the stomach to create a small pouch. This restricts the amount of food that can be consumed at one time and increases the time taken for the stomach to empty. The patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion.

The Roux-en-Y laparoscopic gastric bypass, on the other hand, involves the creation of a small pouch from the upper stomach, accompanied by bypass of the remaining stomach. This restricts the volume of food, which can be eaten. The stomach may simply be partitioned or it may be totally divided into two parts, to reduce the possibility that the two parts of the stomach will heal back together and negate the operation.

Sleeve gastrectomy is a surgical procedure in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape.

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