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Gastric Bypass vs. Lap-Band continued...

“It’s very clear: Bypass is better than band, period. Bypass resolves more diabetes than band, period. And if you are diabetic with obesity, the best treatment is Roux-en-Y gastric bypass,” says study researcher Guilherme M. Campos, MD, a bariatric surgeon who is now with the University of Wisconsin School of Medicine and Public Health in Madison.

Campos notes that his study only included patients who had BMIs over 35 but that the FDA had recently approved the Lap-Band procedure for people with BMIs as low as 30 who also had at least one other obesity-related medical condition.

“I think for patients with the lower tier BMI, it may be worth considering laparoscopic banding as an option,” he says.

Lap-Band Manufacturer Responds

Cathy Taylor, senior manager of corporate communications at Allergan Inc., writes in an email to WebMD, “This is a single-center study, not a randomized, double-blind, and multi-center clinical trial, and the study’s conclusions are not in line with the vast findings from the published literature. The LAP-BAND System procedure is inherently safer than gastric bypass, given bypass is an invasive procedure... In addition, the medical literature supports that at five years, which is the measure of sustainable weight loss, weight loss achieved with the Lap-Band System is on par with weight loss achieved from gastric bypass. In terms of resolution of diabetes, a landmark study published in JAMA in 2008 found that gastric banding also helps resolve diabetes over time.”

Gastric Bypass vs. Sleeve Gastrectomy

For the second study, researchers in Taiwan recruited 60 moderately obese patients (BMIs between 25 and 35) who had poorly controlled type 2 diabetes. They randomly assigned half the patients to get a gastric bypass. The other half had a sleeve gastrectomy, which involves surgically removing a portion of the stomach, creating a small “sleeve” of stomach about as wide as a garden hose. In this procedure there is no bypass of the small intestine.

After 12 months, twice as many patients in the gastric bypass group (93%) saw their diabetes resolve compared to those who had sleeve gastrectomies (47%). The bypass group also lost more weight, had lower bloodglucose levels, and had better total and LDLcholesterol levels than the gastrectomy group, a finding that surprised researchers.

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