A new matched-paired study published online in Archives of Surgery found that both Roux-en-Y gastric bypass and gastric band bariatric procedures have excellent weight loss outcomes at six years. The findings indicated that gastric bypass patients lost 78.5 percent of their excess weight after six years, and gastric banding patients lost 64.8 percent. For the study, researchers conducted a matched-pair analysis of 221 patients who received a gastric bypass versus 221 patients who received a gastric band procedure in 1998 through 2005. Their analysis indicated that, on average, maximal weight loss was achieved 18 months after a gastric bypass procedure, while maximum weight loss was achieved on average 36 months after gastric banding. At the six year mark, both groups had experienced significant reductions in Body Mass Index (BMI), with just 2.4 percent of the Roux-en-Y group having a BMI greater than 40, and 13.8 percent of the gastric banding group. Both groups also reported improved quality of life. The bypass group saw better improvements in lipid profiles and fasting glucose levels, but there were significantly more early complications after Roux-en-Y (17.2%) than after gastric banding (5.4%). This is not surprising being that Roux-en-Y is more complex surgically, requiring both a longer operative time and longer hospital stay.
We spoke with Dr. Christine Ren Fielding, a top weight loss surgeon in New York, about the study. She told us that this is an interesting paper on several levels, but particularly in presentation. She said “if you look at the data, you’ll see they have done a good job scientifically in trying to match the groups to be even (band vs bypass) and have very high follow-up level at six years (over 90%). Aside from the paper’s higher band erosion rate, which was over seven percent, the weight loss outcomes and complications are all on par with the rest of the world. However, a seven percent erosion rate is alarmingly high, and we have not seen this issue with any other US study or surgical practice.” Dr. Ren Fielding added that “Mexican surgeons’ experience in the 1990’s had a ten percent band erosion rate, and they realized it was their surgical technique that caused the bands to erode. They modified their technique and band erosion decreased. Surgical technique and surgical ability can affect complication rates of any surgery.”
We spoke with Dr. Ren Fielding about an analysis from a paper (1) that she and her colleagues published in 2010 about gastric banding. Here she cites some statistics from their analysis:
In our vast experience of 2,909 patients who received gastric banding between January 1, 2000, and February 29, 2008, 363 (12.2%) experienced one or more complications. The most common complications were band slip (4.5%) and port-related problems (3.3%). Only seven (0.2%) patients had band erosion. Eleven patients (0.4%) underwent re-operations for weight gain. There were 10 (0.34%) deaths during the study period. Three patients died within 30 days of operation, two (0.06%) related to surgery and one from a motor vehicle accident. Seven died from causes unrelated to surgery during the course of the study. Our Conclusions: LAGB is a relatively safe procedure with few early or late complications. Few patients undergo re-operation for weight gain, and mortality is very rare.
Dr. Ren Fielding also addressed the early complication rates in the match-paired study, saying “I am troubled by the fact that the authors do not give the details of the specific types of complications and how serious they are. We know that not all complications are alike. For example, a wound infection treated with antibiotics is not the same as an anastomotic leak which requires re-operation and extended hospitalization. In our publication (2), we showed that gastric bypass complications are far more serious than gastric band complications. Secondly, if you look at the weight loss results, they are excellent for both bypass and band. The paper shows that the weight loss from gastric bypass is 78.5% excess weight loss (EWL), and from the band it is 65% EWL. This appears to be a very large difference. However, when you convert it to how many pounds this is, for example, in a 5’5″, 270 lbs woman (BMI 45), it is a difference of 17 lbs. Therefore, one must ask oneself – considering that the early complications of gastric bypass is higher and possibly more serious than the gastric band – is 17 lbs worth the risk? In addition, several prior studies have documented that with the faster weight loss seen after the gastric bypass, there is more loss of lean body mass (muscle and bone) compared to banding, so the actual difference in fat loss is less than these numbers would suggest.”
Dr. Ren Fielding concluded that having a 65% EWL with the gastric band is terrific. She explained, “That would be a 100 lbs weight loss for the 5′ 5″ 270 lbs woman. It is true that with a gastric band device, delayed complications can happen, just like they can do with a car for example. A part may need to be changed or repaired. Although these delayed complications from a band do require an operation, it is usually a straight-forward uncomplicated surgery.”
Dr. Laura Machado of Sacramento Bariatric Medical Associates also spoke to us. She said, “this is an excellent study on the two most common procedures performed for weight loss; the gastric bypass and adjustable gastric band. These procedures offer patients a clear choice in the degree of surgery and timing of expected outcomes. Both provide durable and significant weight loss and associated health benefits. The study demonstrates what bariatric surgeons experience in their practices… the procedures work!”
With a high level of experience in both the gastric bypass and gastric band, Dr. Machado said: “The magnitude of surgery associated with gastric bypass is reflected in the greater weight loss, more rapid results, and metabolic benefits of the procedure. The more we learn about the mechanisms working behind the scenes with this operation, the more we understand the improvement in blood glucose levels, lipids, and metabolic rate that we see in our patients. It is a more involved procedure, so the increase in early complications is expected but manageable. For those patients who need more rapid control of weight and other serious health conditions, gastric bypass remains an excellent option. The most common comment I hear from patients is, ‘I just wish I did this sooner’.
“Adjustable gastric banding offers a more gradual rate of weight loss with the least invasive approach. The adjustability remains a clear advantage of the gastric band. For those patients more concerned about potential complications or nutritional issues, the gastric band is an excellent option,” Dr Machado concluded.
(1) [Safety of the laparoscopic adjustable gastric band: 7-year data from a U.S. center of excellence. Carelli AM, Youn HA, Kurian MS, Ren CJ, Fielding GA. Surg Endosc. 2010 Aug;24(8):1819-23]
(2) [Objective comparison of complications resulting from laparoscopic bariatric procedures. Parikh MS, Laker S, Weiner M, Hajiseyedjavadi O, Ren CJ. J Am Coll Surg. 2006 Feb;202(2):252-61]
Weight Loss Studies & Clinical