Feb. 23, 2011 -- Gastric bypass, the most commonly performed surgery for obesity in the U.S., appears to help patients lose more weight and may treat diabetes more effectively than newer techniques, two studies show.
The studies, which are published in the Archives of Surgery, compared traditional gastric bypass to two newer interventions -- laparoscopic gastric banding (Lap-Band) and sleeve gastrectomy.
In both studies, bypass offered more dramatic results, perhaps because the procedure reroutes digestion, bypassing a portion of the small intestine. Experts say the studies show why it’s important for people considering weight loss surgery to understand the trade-offs.
“The Lap-Band has fewer complications and is overall a safer procedure,” says Harry C. Sax, MD, a bariatric surgeon at the Warren Alpert School of Medicine at Brown University in Providence, R.I. “However, the weight loss from the Lap-Band is more modest, and we’re not clear how durable they will be long term.”
“In some cases, the riskier procedure, that is the Roux-en-Y gastric bypass, may offer greater benefits. That’s certainly some of the data that are coming out looking at the management of diabetes,” says Sax, who wrote a perspective that accompanied the studies.
In the first study, researchers in the bariatric surgery program at the University of California, San Francisco matched 100 patients who had chosen Lap-Band to 100 patients of the same age, sex, race, and BMI who had chosen a gastric bypass. In Lap-Band, an adjustable band is placed around the top of the stomach to create a smaller stomach pouch, leading to reduced food intake. The commercially available laparoscopic gastric banding system Lap-Band was used in the study. The Realize Adjustable Gastric Band is another commercially available system.
After one year, gastric bypass patients had lost nearly twice as much body weight as those who’d chosen Lap-Band. Of the 68 patients who had type 2 diabetes before surgery, a greater proportion who had gastric bypass saw their diabetes improve or resolve compared to those who got bands, 75% vs. 50%, respectively. Patients in the bypass group also scored better on measures of self-esteem and physical and social functioning compared to people who’d gotten Lap-Band.
“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.