A study of two popular types of bariatric surgery suggests that Roux-en-Y gastric bypass is associated with better weight loss and a greater improvement in comorbidities than gastric banding.
The study findings further suggest that gastric banding involves more long-term complications and higher reoperation rates than gastric bypass, while gastric bypass has a higher rate of early complications.
According to the researchers, the study, which was published in the January 16th online edition of the Archives of Surgery, shows that gastric bypass “seems clearly superior” to gastric banding.
While the researchers based their conclusion on study data, it is important to consider the study design and other factors involved in weight loss surgery before we can say that one procedure is definitively better than another.
For this study, researchers enrolled 442 patients in Switzerland with a body mass index (BMI) of more than 40 and less than 50. The study was a matched-pair design: patients selecting gastric bypass were matched according to sex, age, and BMI to patients selecting gastric band (some gastric band patients did not have a match so they were excluded from the study). The operations were all performed laparoscopically by the same surgeon between March 1998 and May 2005.
After six years of follow-up based on 92.3% of the patients, the researchers noted the following outcomes:
- Rate of early complications was higher after gastric bypass than gastric banding (17.2% vs 5.4%)
- Weight loss was quicker after gastric bypass than gastric banding (maximal weight loss was reached on average 18 months after gastric bypass and 36 months after gastric banding)
- Excess weight loss was greater after gastric bypass than gastric banding (78.5% vs 64.8%)
- More long-term complications after gastric banding than gastric bypass (41.6% vs 19%)
- More reoperations after gastric banding than gastric bypass (26.7% vs 12.7%)
- Comorbidities improved more after gastric bypass
Two prominent bariatric surgeons offer their own perspectives as to the significance of the findings:
- In an accompanying article, Jacques Himpens, MD, of Saint Pierre University Hospital in Brussels says “I personally agree with them. However, before we make from this conclusion a paradigm, a few caveats remain.” He goes on to mention the possibility of bias in case-control studies vs randomized trials and that a prospective study of matched patients in two centers with different surgeons might provide better evidence due to surgeon proficiency and preference for one procedure over another as “a well-performed GB is better than a poorly executed RYGBP”, and the appealing advantage that gastric banding is more easily reversible.
- In Scope, a Stanford Publication, John Morton, MD, MPH, associate professor of surgery and director of bariatric surgery at Stanford Hospital & Clinics, states “you have to take these findings with a grain of salt” and take into account that the trials were not randomized. He mentions that the study findings are important but that “we need to do a randomized trial comparing these two procedures to provide a clearer picture…unfortunately, the funding just isn’t available for such randomized surgical trials so we have to rely on comparative studies like these.”
While the study provided some important information and insights, it is practically impossible to arrive at an accurate comparison based on just one study. Weight loss surgery involves so many variables ranging from patient selection to surgeon proficiency, that patients and surgeons must carefully consider all options and decide what procedure is the best fit for a specific patient.
