Compared to gastric banding in obese patients, Roux-en-Y gastric bypass is associated with more rapid and more sustained weight loss, according to a study.
Sebastien Romy, MD, of Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and colleagues noted that although Roux-en-Y gastric bypass triggers higher early morbidity, there are more long-term complications and re-operations after gastric banding.
"At the present time, RYGBP seems clearly superior to GB when treating morbidly obese patients, who should be informed accordingly," they wrote.
The prevalence of morbid obesity has increased substantially over the past 20 years, the authors noted, with a recent survey showing bariatric procedures more than doubled between 2003 and 2008. In the United States, the increase was much greater for GB than RYGBP. In background information for the study, the researchers attributed that fact to a perception by physicians and patients that GB is a "simple, safe and reversible operation," and said it also could arise from an industry-driven marketing campaign.
The study included a total of 442 patients (221 in both the GB and RYGBP groups) who were matched according to sex, age and initial body mass index. Follow-up was 92.3% at the end of the study period, which was six years postoperatively.
The results indicated early morbidity was higher after RYGBP than after GB (17.2% vs 5.4%) but weight loss was quicker, maximal weight loss was greater and weight loss remained "significantly better" after RYGBP until the sixth postoperative year.
At six years after GB, there were more failures (defined as a BMI of greater than 35 or reversal of the procedure/conversion) at 48.3% vs. 12.3% after RYGBP, the results showed. There also were more long-term complications (41.6% vs 19%) and more re-operations (26.7% vs 12.7%) after gastric banding.
As the procedures related to comorbidities, the total cholesterol level remained unchanged after GB but significantly decreased after RYGBP. The initial lipid profile was similar for the two groups, but the improvement after five years was "significantly better" after RYGBP. Mean fasting glucose also had a tendency to be lower after RYGBP after three years.
"On the basis of our results and the analysis of the literature, we conclude that RYGBP provides better, more rapid and more sustained weight loss, resulting in better correction of comorbidities than GB," the researchers wrote, adding that their results should be confirmed by a large randomized study with long-term follow-up.
The study appeared Monday on the website of the Archives of Surgery. To read a summary and access the study via subscription or purchase, visit http://bit.ly/xgUqpU.
Sebastien Romy, MD, of Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and colleagues noted that although Roux-en-Y gastric bypass triggers higher early morbidity, there are more long-term complications and re-operations after gastric banding.
"At the present time, RYGBP seems clearly superior to GB when treating morbidly obese patients, who should be informed accordingly," they wrote.
The prevalence of morbid obesity has increased substantially over the past 20 years, the authors noted, with a recent survey showing bariatric procedures more than doubled between 2003 and 2008. In the United States, the increase was much greater for GB than RYGBP. In background information for the study, the researchers attributed that fact to a perception by physicians and patients that GB is a "simple, safe and reversible operation," and said it also could arise from an industry-driven marketing campaign.
The study included a total of 442 patients (221 in both the GB and RYGBP groups) who were matched according to sex, age and initial body mass index. Follow-up was 92.3% at the end of the study period, which was six years postoperatively.
The results indicated early morbidity was higher after RYGBP than after GB (17.2% vs 5.4%) but weight loss was quicker, maximal weight loss was greater and weight loss remained "significantly better" after RYGBP until the sixth postoperative year.
At six years after GB, there were more failures (defined as a BMI of greater than 35 or reversal of the procedure/conversion) at 48.3% vs. 12.3% after RYGBP, the results showed. There also were more long-term complications (41.6% vs 19%) and more re-operations (26.7% vs 12.7%) after gastric banding.
As the procedures related to comorbidities, the total cholesterol level remained unchanged after GB but significantly decreased after RYGBP. The initial lipid profile was similar for the two groups, but the improvement after five years was "significantly better" after RYGBP. Mean fasting glucose also had a tendency to be lower after RYGBP after three years.
"On the basis of our results and the analysis of the literature, we conclude that RYGBP provides better, more rapid and more sustained weight loss, resulting in better correction of comorbidities than GB," the researchers wrote, adding that their results should be confirmed by a large randomized study with long-term follow-up.
The study appeared Monday on the website of the Archives of Surgery. To read a summary and access the study via subscription or purchase, visit http://bit.ly/xgUqpU.
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