Obesity surgery has become increasingly popular, but deciding on the right procedure can be a tough choice.
Now, a new study suggests that for extremely heavy patients, gastric-bypass surgery may have fewer complications, a greater reduction in obesity-related diseases, and more weight loss when compared with so-called gastric banding.
The researchers compared laparoscopic Roux-en-Y gastric bypass, which involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions, with laparoscopic adjustable gastric banding. This procedure calls for surgeons to place a band-like device around the stomach, dividing the stomach into two smaller compartments.
"We wanted to find the most effective procedure, not necessarily the least invasive one," said lead researcher Dr. George S. Ferzli, from the department of surgery at the State University of New York Health Science Center of Brooklyn.
"In the super obese, the bypass was much more effective, in terms of outcomes, weight loss and reduction of morbidities," Ferzli added.
In their study, the researchers evaluated the records of 106 patients who had one of the two procedures. All the patients had a body-mass index (BMI) above 50. A BMI of 18.5 to 24.9 is considered normal; a BMI of 25 to 29.9 is overweight; and obesity begins with a BMI of 30 or above.
Sixty of the patients in the study had gastric banding, and 46 underwent gastric bypass.
The researchers found that after 30 days, 78 percent of the patients who had gastric banding suffered complications, including dehydration and vomiting, compared with 28 percent of those who underwent gastric bypass surgery. And gastric banding patients recorded less weight loss: a BMI decrease of 9.8 points, compared with 26.5 for patients who had gastric bypass.
Moreover, almost 80 percent of the gastric bypass patients were very satisfied, and none was dissatisfied with or regretted having had the procedure. In contrast, only 46 percent of gastric banding patients were very satisfied, 35 percent said they were satisfied and 10 patients reported dissatisfaction or regret.
The findings are published in the July issue of the Archives of Surgery.
When it comes to choosing between the two procedures, Ferzli believes much depends on the patient's eating habits. Since the band allows liquids to pass through to the stomach, it may not be the best procedure for those who can't control their eating after surgery, he said.
On the other hand, some super-obese patients have medical problems that may prohibit them from undergoing a bypass, Ferzli said. For these patients, banding -- which is less invasive -- may be the best choice, he said.
"Postoperative support, nutritional follow-up and psychological follow-up is as important as the surgery itself," Ferzli added.
Another expert thinks the choice of procedures should be based on the patient's perception of acceptable risk.
"This study corroborates other studies comparing these procedures," said Dr. Philip R. Schauer, president of the American Society for Bariatric Surgery, and director of the Cleveland Clinic Foundation's Bariatric and Metabolic Institute. "These are the two most common operations performed in the United States for weight loss," he added.
However, Schauer believes the short follow-up with the patients in the study was a shortcoming. "How rapidly one loses weight is not that important," he said. "It [the study] does not say what the long-term results are. It does not say that gastric bypass results in superior weight loss, in the long term, compared to the band."
Schauer also thinks there were too few patients in the study to come to definitive conclusions, particularly about the risks of the procedures and their complication rates.
"Both operations result in significant weight loss," Schauer said. "Gastric bypass has greater weight loss in the short term. This may mean that they have better long-term weight loss, but you can't tell that from this study."
More information
The National Institutes of Health can tell you more about weight-loss surgery (
www.nlm.nih.gov ).
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