Better long-term outcomes were reported after gastric bypass than after adjustable banding.
The term "super morbidly obese" refers to patients with body-mass index higher than 50 kg/m2. To compare outcomes of two types of bariatric surgery for these patients, researchers in New York present data from a series of 106 patients (mean BMI, 56; mean weight, 153 kg; mean age, 42).
Sixty patients underwent laparoscopic adjustable gastric banding (with the Lap-Band system), and 46 underwent laparoscopic roux-en-Y gastric bypass. All procedures were done by a single surgeon. Patient preference determined the choice of procedure; despite lack of randomization, researchers found no significant differences between groups in age, sex, or BMI. Rates of complications — most frequently emesis and dehydration — within 30 days were similar in the 2 groups (about 18%). However, later complications (during a median follow-up of 16 months) were more common with banding than with bypass (78% vs. 28% of patients). Fifteen patients (25%) in the banding group required reoperation (including 12 revisions of subcutaneous ports), compared with 3 patients (7%) in the bypass group. Bypass patients lost a greater percentage of their excess weight than did banding patients (mean, 52% vs. 31%).
Comment: Although patient preferences should play a role in selection of a bariatric procedure, this nonrandomized comparison suggests better long-term outcomes with gastric bypass than with adjustable banding for super morbidly obese patients. This study was conducted at a single institution by a single surgeon, but its findings are similar to those from a previous single-center study of patients with a mean BMI of 48 (Journal Watch Jan 7 2005).
— Allan S. Brett, MD
Citation(s):
Bowne WB et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Arch Surg 2006 Jul; 141:683-9.