As the rates of obesity continue to increase throughout the United States, it is not surprising that more and more people are turning to surgical solutions to loose weight. In fact, over the past decade there has been a 10-fold increase in the number of bariatric surgeries performed each year.
Gastric Bypass Surgery vs Lap Band
While there are several commonly used surgical procedures to help induce weight loss, there is limited research comparing the safety and effectiveness of each of these procedures.
A recent study published in The American Journal of Medicine found that the Roux-en Y gastric bypass procedure produces greater weight loss and improvements in obesity-related health conditions, such as diabetes, high blood pressure and sleep apnea as compared to the laparoscopic adjustable gastric banding procedure. This observational study is one of the first to assess the scientific literature to determine if there are differences between these two different surgical procedures.
An Epidemic Growing Out of Control
The rate of obesity in the United States is steadily growing into a massive health epidemic. Approximately 72 million Americans or one-third of the entire population is obese with more than 112,000 deaths annually due to complications associated with obesity.
Having a body mass index or BMI of 30 kg/m2 or greater is considered obese and more than 40 kg/m2 is morbidly obese. Calculated by using a mathematical equation that essentially divides a person’s height by weight, BMI is the standard measurement by which healthcare professionals determine whether a person is underweight, normal weight or overweight.
When a person’s BMI increases so high that they become classified as obese or morbidly obese, there becomes an increased risk of early death as well as an increased risk in developing other health-related complications including diabetes, high blood pressure, high cholesterol, heart disease, arthritis, sleep apnea and gallbladder disease. However, studies have shown that significant weight loss can help reduce these long-term complications.
Not All Weight Loss Treatments Are Equal
Current treatments to loose excessive weight include low-calorie diets, behavioral changes, exercise, drug therapy and bariatric surgery. Unfortunately, not all the available treatment options are highly effective, especially for those that are morbidly obese.
Low-calorie diets have been shown to yield an initial weight loss of less than 15 percent of a person’s total body weight with most of the weight gained back after five years. More aggressive treatment with drug therapies such as orlistat or sibutramine also produces limited weight loss averaging only nine to 15 pound [5].
The failure of these types of treatments has led to the development of several stomach and intestinal surgical approaches to help those with morbid obesity loose significant amounts of weight. One recent study found that those who undergo bariatric surgery achieve an average weight loss of 88 pounds and have resolution or improvement in other obesity-related complications. Other studies have demonstrated that surgery also reduces long-term mortality or death.
Roux-en Y Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding
The most common bariatric surgery in the United States is the Roux-en Y bypass procedure. In this surgery, a part of the stomach is removed and then is reconnected or “bypassed” to a lower part of the small intestine, resulting in a smaller stomach for food intake and less overall food absorption within the small intestine.
Another procedure that is more common in Europe and Australia is the Laparoscopic Adjustable Gastric Banding (LAGB) procedure where food intake is limited by placing an inflatable tube around the stomach. Stomach size can be adjusted by adding or removing saline through a tube that is implanted during the bariatric surgery and remains accessible outside of the body.
Since there has been such a substantial increase in bariatric surgery over the past 10 years, it is important for both physicians and patients to better understand the differences, if any, between the safety and effectiveness of the different methods of surgery.
The recent American Journal of Medicine study previously mentioned was designed to determine differences in outcomes of patients who undergo the Roux-en Y bypass procedure compared to the laparoscopic adjustable gastric banding procedure. The study investigators searched the scientific literature and found 14 studies of at least one year duration that directly compared the two bariatric procedures.
Information such as amount of body weight loss, improvement in obesity-related health complications, quality of life, surgery complications and long-term side effects from each study were analyzed. The majority of patients included in the analysis were female (80 percent) with an average age of 40 years old with a BMI of at least 45 m/kg2.
Patients Lose More Weight with Gastric Bypass than with LAGB
The analysis found that weight loss was significantly higher (25 percent) after one year in those patients who underwent a Roux-en Y bypass procedure compared to those receiving a laparoscopic adjustable gastric banding procedure.
Additionally, the only randomized study that appeared in the scientific literature found a 51 percent and 35 percent reduction in excess body weight at one year in those receiving the Roux-en Y bypass and laparoscopic adjustable banding procedure, respectively. After five years, excess body weight totaled 67 percent in the Roux-en Y group compared to 47 percent in the laparoscopic adjustable gastric banding group.
Only one of 24 patients in this study that underwent the Roux-en Y bypass procedure did not loose weight while nine of 26 in the laparoscopic group failed to loose any weight whatsoever.
Gastric Bypass More Effective at Reducing Obesity Comorbidities than LAGB
Furthermore, two of the studies included in the analysis demonstrated a clear advantage for the Roux-en Y bypass procedure in the reduction of obesity-related health complications such as diabetes.
In one of these studies, all patients who had diabetes prior to receiving a Roux-en Y bypass achieved normal blood glucose levels following the surgery compared to only 40 percent of those receiving the laparoscopic adjustable gastric banding procedure.
Gastric Bypass Patients are Happier than LAGB Patients
Overall patient satisfaction was higher in those patients receiving the Roux-en Y bypass procedure. Eighty percent of those receiving this procedure reported being very satisfied with the surgery.
In fact, no patients reported being unsatisfied or regretted undergoing the procedure. On the flip side, only 46 percent of those who received the laparoscopic adjustable gastric banding reported being satisfied with the procedure.
Another 19 percent of patients in this group were unsatisfied and even actually regretted having this method of weight loss surgery done.
LAGB is Safer than Gastric Bypass
The analysis did find advantages for the laparoscopic adjustable gastric banding procedure. Since this procedure is a technically less demanding surgery, operation times were shorter by an average of 68 minutes and length of stay in the hospital following surgery was about two days shorter. There were fewer deaths seen in this group as well, although overall mortality was low in both groups. LAGB has very low mortality rates (0-0.1%) and it’s becoming more and more popular in the US especially in the super obese and older patients.
The study also concluded that more research is needed to identify if there are some groups of patients that may benefit more from the laparoscopic adjustable gastric banding procedure. Additional randomized, controlled and comparative trials are needed to better determine if there are sub-groups of patients that may better benefit from the lower short-term complication rates since with this form of bariatric surgery.
Roux-en Y Bypass Remains The Procedure of Choice
Results from this study clearly demonstrate that the Roux-en Y bypass procedure should remain the bariatric surgery of choice. However, as with any surgical procedure the risks and benefits should be discussed between physician and patient so that the best procedure for the patient is chosen.
