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Long term, gastric bypass beats out banding: study

By Genevra Pittman

NEW YORK (Reuters Health) - Among weight-loss surgery options, gastric bypass comes with more complications shortly after surgery than gastric banding, but makes up for it with fewer long-term side effects and repeat operations, new research suggests.

People who got bypass surgery also lost weight faster, and more kept it off, in the study of more than 400 obese Swiss patients.

"What we would like with any of the (weight-loss) procedures ideally would be to have the least long-term complications, certainly the least long-term complications requiring (repeat) surgery," said Dr. Michel Suter, a surgeon from the Hopital du Chablais, Aigle, who worked on the study.

"There are drawbacks with bypass, there are side effects, and we have to take them into account," he told Reuters Health. But "overall, if I had to choose between the procedures, I certainly recommend the bypass."

Still, one researcher not involved in the study said that when complications do happen with gastric bypass, they are often more serious than complications after banding.

Suter and his colleagues looked back at records of 442 obese patients who underwent weight-loss surgery at their hospitals between 1998 and 2005.

To qualify for surgery, all patients had to have a body mass index -- a measure of weight in relation to height -- of at least 40, or at least 35 if they also had an obesity-related illness. That's the equivalent of a five-foot, six-inch person weighing at least 248 pounds or 217 pounds, respectively.

Half of the patients had gastric band procedures, which involve placing a band around the top of the stomach to limit its size to a small pouch. The other half were treated with gastric bypass, when part of the stomach is stapled off and then rerouted to bypass a segment of the small intestine. The two groups were similar in terms of their age and initial weight.

Doctors checked in with those patients at least twice a year for the next six years post-surgery.

Complications in the month after the procedure -- which typically include infections -- were more common after gastric bypass than after banding: 17 percent of bypass patients had any surgery-related problems, compared to five percent in the banding group.

"The operation itself is a little more complicated and a little more risky," Suter explained.

But after that point, the bypass group lost weight faster, put less of it back on and suffered fewer long-term complications, including those that called for a repeat procedure.

Six years post-surgery, 12 percent of bypass patients had a body mass index above 35, considered severely obese, compared to one-third after gastric banding.

And thirteen percent of patients needed re-operation after complications with gastric bypass, versus close to 27 percent following banding.

The long-term complications of gastric banding were generally related to the band eroding and needing to be removed, food intolerance or stretching of the esophagus, the researchers reported Monday in the Archives of Surgery.

With gastric bypass, patients most often had internal hernias, a type of bowel blockage that can be life-threatening if not treated.

'NOT ALL COMPLICATIONS ARE ALIKE'

Dr. Christine Ren-Fielding, a weight-loss surgeon at the New York University School of Medicine, said that her research has suggested gastric bypass complications tend to be much more serious than complications related to banding.

"We all know that not all complications are alike," Ren-Fielding, who was not involved in the new study, told Reuters Health by email. "For example a wound infection treated with antibiotics is not the same as a...leak which requires re-operation and extended hospitalization."

While Ren-Fielding said banding has been found to be "a relatively safe procedure," technique and surgeon experience can affect outcomes of any surgery.

Weight-loss surgery typically costs around $20,000. Gastric banding may be cheaper than bypass initially because of a simpler procedure and shorter hospital stay -- but Suter said that the need for band adjustments over time may drive up costs.

When it comes to choosing a procedure, Ren-Fielding said, "My philosophy is one of helping the patient be successful and optimizing outcomes, regardless of which operation they have, because all bariatric surgeries have their overwhelming benefits in treating the disease of obesity."

"I'm not at a point when I would say, 'No way' to a patient who asks for a band and has no contraindications to the band," Suter said.

Still, he added, "I discourage them to have a band because I don't want to operate on them two or three times -- one time is enough. Bypass is more definitive."

SOURCE: http://bit.ly/yw13CX Archives of Surgery, online January 16, 2012.

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