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Are you considering bariatric surgery as a means to lose weight? If so, you are one of many. The number of bariatric surgeries performed in the United States has increased from about 13,000 annually in 1998 to 121,000 in 2004 [1]. This is not surprising when you consider that nearly 8% of some populations in the United States have a Body Mass Index (BMI) of 40 or above, putting them in the category of class 3 obesity. Class 3 obesity is a serious condition and is associated with both premature death and an increased risk of health problems such as diabetes, hypertension, high blood cholesterol, heart disease, osteoarthritis, sleep apnea, and gallbladder disease. Current guidelines from the National Institutes on Health recommend that people who meet the criteria for class 3 obesity or have a BMI of at least 35 along with serious health problems consider undergoing bariatric surgery as a method of weight loss.

Significant weight loss by a person who is morbidly obese has been shown to improve social functioning, quality of life, and health, and bariatric surgery was developed specifically to induce significant weight loss. When compared to other weight loss strategies, bariatric surgery seems to have some advantages for the morbidly obese. Dietary measures designed to induce weight loss tend to result in the loss of less than 15% of initial body weight [2], while medication and behavioral therapy resulting in an average long-term weight loss of 4 to 7 kg; these methods also fail to significantly improve health problems related to obesity. In comparison, the average weight loss after undergoing bariatric surgery is 40 kg, and many obesity-related health problems are resolved or improved [3].

When looking at bariatric surgery as a weight loss option, most people will be choosing between either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding. These two types of weight loss surgery are the ones most commonly performed, with Roux-en-Y gastric bypass the standard procedure in the United States and laparoscopic adjustable gastric banding common in Europe and Australia. In order to compare the effectiveness and complications involved in these common surgeries, Dr. Tice and his colleagues at the University of California conducted a review of the research that has been reported on both procedures [4].

Gastric Bypass or Banding? The Study

Eighty percent of the patients in the studies examined by Dr. Tice and colleagues were female, and the average patient was about 40 years old with an initial BMI of 45 (class 3 obesity). The patients underwent either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding, both primarily restrictive procedures designed to limit food intake. In Roux-en-Y gastric bypass, a small stomach pouch is surgically created, and the route of the small intestine is modified so a portion of the stomach and small intestine is bypassed. In laparoscopic adjustable banding, an inflatable tube is placed just below the junction of the esophagus and stomach. The tube is inflated via a saline solution injected through a subcutaneous port, which allows the size of the outlet to be adjusted.

In general, there have been few high-quality studies performed on the two bariatric surgeries, and sample sizes in the best available studies tend to be low. Randomized clinical trials are the best way to compare the risks and benefits of gastric bypass and gastric banding surgeries, and information from only one such trial was available for analysis. Future studies will hopefully shed even more light on the relative merits of different bariatric surgery treatments.

The Results

The available research data shows both advantages and disadvantages to each type of bariatric surgery. Some of the main issues considered include:

Weight loss

When patients’ weight loss results were compared one year after surgery, a 25% difference was found in the amount of weight lost by the two groups. The difference favored the gastric bypass group, with patients who underwent that procedure consistently having better weight loss outcomes. In the highest quality study – the only randomized clinical trial – only 4% of the gastric bypass patients failed to lose weight, while 35% of the gastric banding group did not lose their excess weight [5].

Resolution of comorbidities

Gastric bypass patients were more likely to experience resolution or improvement of weight-related conditions such as diabetes, hypertension, and sleep apnea [6,7]. One study, consisting of patients with a pre-surgery BMI of 50 or above, found that all diabetic patients treated with gastric bypass surgery were subsequently able to control their blood glucose levels without medication, compared to only 40% of patients who were treated with gastric banding.

Complications & recovery

Gastric banding surgery is generally considered less invasive than gastric bypass as well as potentially reversible, and this is reflected in a shorter operating time (by a median of 68 minutes), fewer short-term complications, and a subsequent hospital stay that was on average 2 days shorter. Mortality rates, although low for both procedures, also appear to be slightly lower for gastric banding. However, long-term complications were more likely to occur in patients who had received gastric banding surgery rather than gastric bypass.

Patient satisfaction

Only one of the studies examined reported information regarding patient satisfaction with their procedure; in that study, patients who received gastric bypass surgery were more satisfied overall than those who underwent gastric banding. While approximately 80% of the gastric bypass group was very satisfied with the procedure, only 46% of the gastric banding group reported being very satisfied. In addition, none of the gastric bypass patients indicated they were unsatisfied with the procedure or regretted having it performed [8].

Depending on your particular situation and concerns, you may find that one type of surgery is better suited to you than another. There are many factors to consider, including your initial BMI, your particular health concerns, your doctor’s recommendation, and the country in which you plan to have the surgery performed. However, the overall results tended to favor Roux-en-Y gastric bypass over laparoscopic adjustable banding. If you are planning to have your surgery performed in the United States, there doesn’t appear to be a compelling reason to deviate from the standard procedure.
References

1. Zhao Y, Encinosa W. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Statistical brief #23. Rockville, MD: Agency for Healthcare Research and Quality; 2007.

2. Bennett W. Dietary treatments of obesity. Ann N Y Acad Sci. 1987; 499:250-263.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

3. Tice et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. The American Journal of Medicine. 2008;121.

4. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127-133.

5. Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534-540.

6. Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. Dec 2004;240:975-983.

Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141:683-689.

About the Author

Matthew Denos is a medical researcher at Washington University in St. Louis, MO. He has a particular interest in the field of obesity treatment and sympathizes with people who have found that diet and exercise alone are not effective enough to control their weight. Matthew enjoys reading and writing articles related to weight loss and diet programs and enjoys publishing information about the latest research findings on obesity research. His website can be visited at coupon for bistromd diet nutrisystem promo code find coupon codes for medifast.