Weight Loss: Is Bypass Better Than Banding?
Very Obese Bypass Patients in Study Lost More Weight, Kept It Off Longer
Obesity and Weight Regain
The new study compared outcomes among severely obese patients who had gastric banding and gastric bypass surgeries.
Among the major findings:
- Three years after surgery, 22% of the banding patients were still severely obese (BMI of 35 or greater), compared to 7% of bypass patients.
- Six years after surgery, nearly three times as many banding patients had a BMI of 35 or greater (33% vs. 12%).
- Fourteen percent of the banding patients remained morbidly obese (BMI of 40 or greater) after six years, compared to 2.4% of bypass patients.
- The complication rate immediately following surgery was 17% in the bypass patients and 5% in the banding patients. Six years later, 19% of the bypass patients and 41% of the banding patients reported long-term complications.
Forty-seven of the 221 patients who had the banding procedure (21%) ended up having the bands removed.
“At the present time, Roux-en-Y gastric bypass seems clearly superior to gastric banding when treating morbidly obese patients," researcher Sebastien Romy, MD, and colleagues write.
Ronald H. Clements, MD, who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville, Tenn., says the findings come as no surprise.
“Our experience and that of many others is that close to 25% of these bands end up being removed for some reason such as slippage, erosion, or failure to lose weight,” Clements says.
Role of Consumer Marketing
Clements adds that aggressive marketing by the gastric banding industry has been largely responsible for the dramatic increase in gastric banding procedures.
“It’s common for patients to tell me they want gastric banding because they have seen a commercial for it,” he says. “When I explain the pros and cons of banding, bypass, and sleeve procedures, they often change their minds.”
American Society for Metabolic and Bariatric Surgery (ASMBS) President Robin Blackstone acknowledges that aggressive marketing of gastric banding is an issue.
“The society does not favor the direct-to-consumer type of advertising that we are seeing with gastric banding,” she says. “We recommend that patients seek out a center which offers a variety of procedures and also offers counseling to address the risks and benefits of each one.”
Himpens says gastric banding can be a better option than bypass if patients do not have access to surgeons who specialize in bypass surgery or if they will not be followed closely after surgery.
Clements, Blackstone, and Himpens agree that gastric bypass or sleeve surgeries are generally preferable to banding for one group of patients -- people with type 2 diabetes.
Because bypass and sleeve procedures change a person’s metabolism in addition to promoting weight loss, in many cases diabetes improves or goes away before weight loss occurs.
Banding Industry Weighs In
Allergan Inc., markets the Lap-Band gastric banding system, which is the most widely used gastric band in the U.S.
In a statement, an Allergan spokesperson highlighted what the company called “specific weaknesses” in the study, including:
- The fact that the patients received an older version of the banding system, which is no longer used. The insertion method used has also been replaced since the patients in the study had the procedures, and the new method has a much lower re-operation rate. The researchers did acknowledge that some of the patients in the study used an older system.
- The researchers failed to include many complications that have been associated with bypass surgery in their analysis, including small bowel obstructions, osteoporosis, anemia, and long-term nutritional complications.
- Migration of the band through the stomach wall into the stomach, known as erosion, was much higher in the study participants, 7.7%, than has been typically reported (0.2%-0.5%).
“Although we applaud the high six-year follow-up rate of these bariatric patients, it would be inappropriate to draw conclusions regarding the relative risks and benefits of either procedure based on this single study,” according to Allergan.