Gastric Bypass Might Be Better Than Lap-Band
Extremely obese patients undergoing weight-loss surgery may do better with a procedure that bypasses part of the intestine rather undergoing a banding procedure that creates a small pouch in the stomach, according to a new study released Monday.
Researchers at the State University of New York, Health Science Center of Brooklyn and Lutheran Medical Center, also in Brooklyn, N.Y., looked at two commonly performed types of bariatric surgery in 106 patients who underwent the procedures between February 2001 and June 2004. The study appears in the July edition of the Archives of Surgery.
Sixty patients received a so-called Lap-Band device through a laparoscopic procedure which allows surgeons - through a small incision near the stomach - to place a silicone band around the stomach dividing it into two smaller compartments. The device is designed to restrict food intake and make patients feel full sooner than those with a full-sized stomach.
Forty-three patients underwent another type of procedure known as the laparoscopic Roux-en-Y Gastric Bypass, which involves sectioning off a small portion of the stomach into a pouch that bypasses the first part of the small intestine and connects directly to the lower portions, reducing the amount of calories absorbed by the body from food.
Overall, researchers found patients undergoing the laparoscopic bypass surgery had fewer long-term complications, lost more weight and had larger improvements in other co-morbidities, such as high blood pressure and diabetes, than patients who underwent the lap-band procedure.
The better outcomes of patients undergoing the bypass procedure is likely the result of better compliance among those patients rather than a particular problem with the lap-band. He said the lap-band can allow patients to cheat and consume more calories through liquids because they can still pass fairly easily through the small stomach.
For the band to be successful it requires significant will power, discipline and compliance.
Patients in the study were considered "super" morbidly obese and had body mass indexes of 50 or greater. On average patients in the study weighed roughly 340 pounds before surgery.
Patients undergoing the lap-band procedure were hospitalized for less time with an average of 1.8 days compared with 3.5 days for patients undergoing the bypass procedure. Short-term complications were statistically similar between the two groups.
However, long-term complications, or those that occurred after 30 days or longer, were more common in the lap-band group with 78% of patients experiencing complications compared to 28% in the bypass group. The most common long-term complication was vomiting and dehydration.
The study also showed that 15 patients with the lap-band needed follow up surgery compared to three in the bypass group. The lap-band can be adjusted after initial surgery to be made larger or smaller. Patients in the study were followed for an average of 16.2 months.
Patients who underwent the bypass had an average BMI decrease of 26.5 compared with 9.8 in the lap-band group, however researchers said both procedures produced "satisfactory" amounts of weight loss.
All patients reported fewer co-morbidities after surgery, but the decrease was more pronounced in gastric bypass patients. For example, rates of diabetes dropped to zero from 17.4% before surgery in the bypass group. Rates of diabetes in the lap-band group fell to 11% from 18.3% before surgery.
The typical gastric surgery patient has a pre-surgery BMI of 40. Some patients with BMIs of 35 or more are also considered good surgery candidates if they have another problem linked to being overweight like diabetes.
Although the study focused on patients with BMIs of 50 or greater, patients do better with a bypass rather than a lap-band. However, not every patient is a good candidate for a gastric bypass - for instance, those with certain liver problems, as well as those who've had stomach ulcers - and they might need a lap-band or similar device.