Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity: A Case-Matched Study of 442 Patients

Study Questions:

Does Roux-en-Y gastric bypass provide better results than gastric banding for the treatment of morbid obesity?

Methods:

This was a matched-pair study, which included patients from a common bariatric surgeon with surgeries performed at two different hospitals (a university hospital and a regional community hospital). All patients had a body mass index (BMI) <50 kg/m2. Patients were offered surgery if they had a BMI >40 or >35 with one or more comorbidity after failed conservative therapy and evaluation by a multidisciplinary team. All patients included received their surgeries between March of 1998 and May of 2005. The primary outcomes of interest were operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity.

Results:

A total of 442 patients were matched according to sex, age, and BMI. Of the 253 eligible gastric banded patients, 221 (87.3%) found a suitable matched patient from the Roux-en-Y gastric bypass group. Follow-up rates were 92.8% and 91.9% for the gastric banded group and the Roux-en-Y gastric bypass group, respectively. Over a follow-up period of 6 years postop, early mortality was observed among patients who had Roux-en-Y gastric bypass as compared to gastric banding (17.2% vs. 5.4%, p < 0.001); however, long-term morbidity was similar. Weight loss was faster and maximal weight loss was greater among patients who received Roux-en-Y gastric bypass. Greater weight loss was also observed at the end of the study among Roux-en-Y gastric bypass patients as compared to those who received gastric banding. At 6 years, there were more failures (defined as BMI >35 or reversal of the procedure) after gastric banding (48.3% vs. 12.3%, p < 0.001) compared to Roux-en-Y gastric bypass. Long-term complications (41.6% vs. 19%, p < 0.001) and reoperations (26.7% vs. 12.7%, p < 0.001) were also more frequent with gastric banding compared to Roux-en-Y gastric bypass.

Conclusions:

The authors concluded that Roux-en-Y gastric bypass was associated with better weight loss, but with higher numbers of early complications. However, long-term complications were lower among patients who received Roux-en-Y gastric bypass as compared to gastric banding.

Perspective:

This study provides clinically informative data, which patients and their weight loss team can use to discuss surgery options. However, these data are limited given one surgeon performed all the surgeries, and it is likely that type of surgery varied by year. Given that management of such patients may have improved over time, such factors may have influenced these results.

Keywords: Bariatric Surgery, Surgical Procedures, Elective, Follow-Up Studies, Body Mass Index, Gastric Bypass, Weight Loss, Obesity, Morbid, Hospitals, Community, Gastroplasty, Cardiovascular Diseases


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