Laparoscopic Roux-en-Y gastric bypass vs. Laparoscopic adjustable gastric band.

Despite the level of poverty in South Africa, there is a substantial proportion of the population who are either overweight or obese. The rough figures indicate that approximately half of all women and a quarter of all men in South Africa are overweight, although not all of them to the point of obesity.  Historical data also show that the number of overweight people has been increasing over the last few decades. There are various health risks associated with excessive body mass, and so the weight of the population is something that should receive more attention .

Gastric bypass surgery appears to lead to better long-term results including greater weight loss, resolution of diabetes and improved quality of life compared with sleeve gastrectomy and “lap-band” surgery, according to two international reports.

“Obesity and type 2 diabetes mellitus are currently two of the most common chronic, debilitating diseases in Western countries,” the authors write as background information in one of the articles. The most common surgical procedure for treating diabetes in the United States is the laparoscopic Roux-en-Y gastric bypass, more commonly referred to as gastric bypass surgery. In 2001, the laparoscopic adjustable gastric band, also known as lap-band, was introduced as a less invasive alternative to gastric bypass. Sleeve gastrectomy is another surgical weight-loss procedure, which involves surgical removal of a large portion of the stomach.

To evaluate differing outcomes of bariatric surgeries, Guilherme M. Campos, M.D., now of the University of Wisconsin School of Medicine and Public Health, Madison, formerly of the University of California, San Francisco, and colleagues examined 100 morbidly obese patients (having a body mass index greater than 40) who underwent lap-band surgery. These patients were matched by sex, race, age and initial body mass index (BMI) with 100 patients who underwent gastric bypass surgery.

 All weight loss outcomes were significantly greater for patients who underwent gastric bypass. Average excess weight loss for this group was 64 percent, compared to 36 percent for lap-band patients. Additionally, 86 patients in the gastric bypass group successfully lost more than 40 percent of their excess weight compared with 29 (31 percent) of lap-band patients.

Each group had 34 patients with type 2 diabetes mellitus. Resolution or improvement of type 2 diabetes was significantly better after gastric bypass (26 patients or 76 percent) compared to lap-band (17 patients or 50 percent). At the one-year follow-up, six of eight gastric bypass patients (75 percent) who were using insulin had discontinued its use, while only one patient of six (17 percent) in the lap-bad group had done so.

The overall rate of complications was similar in both groups, with 11 patients (12 percent) in the lap-band group and 14 patients (15 percent) in the gastric bypass group experiencing complications. Early complications (within the first 30 days post-surgery) were higher in the gastric bypass group (11 patients or 11 percent) than the lap-band group (2 patients or 2 percent), however the rate of re-operation was higher in lap-band patients (12 patients or 13 percent) compared to gastric bypass patients (2 patients or 2 percent). No deaths occurred in either group.

“Our study shows that laparoscopic Roux-en-Y gastric bypass, when performed in high-volume centers by expert surgeons, has a similar rate of overall complications and lower rate of re-operations than laparoscopic adjustable gastric band,” the authors conclude. “Because it achieves greater weight loss, increased resolution of diabetes, and better improvement in quality of life, we conclude that, in the setting we studied, laparoscopic Roux-en-Y gastric bypass has a better risk-benefit profile than laparoscopic adjustable gastric band.”

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Bariatric Surgery Support Newsletter December 2012