Obesity is an increasing concern.
The most common surgical procedures for obesity are the gastric bypass and the adjustable gastric banding. However, the indications and results of these techniques are unclear.
In the United States gastric bypass is regarded as the procedure which offers the best weight-loss outcome, but European surgeons prefer laparoscopic adjustable gastric banding.
|Patients in the laparoscopic gastric bypass group were significantly heavier.|
|Journal of the American College of Surgeons|
In this study, doctors from Switzerland and United States compared 2 groups of patients.
The first group included 805 obese patients from Switzerland who had a laparoscopic Swedish adjustable gastric banding (LAGB) performed between 1997 and 2001. The second group included 456 patients from the United States who had a laparoscopic gastric bypass (LGB) performed between 1998 and 2001.
The research team found that the patients in the LGB group were significantly heavier than those in the LAGB group.
However, they determined that postoperative stay after LGB was significantly less than after LAGB. This may be related to health system differences between the 2 countries.
The team identified 9 major intraoperative complications in the LGB group and 10 in the LAGB group.
They also found that 9 patients in the LGB group and 24 in the LAGB group required a conversion to another procedure. The primary cause of conversion was related to the obesity.
In the first 30 days following surgery the team found there were no deaths in the LAGB group and 2 in the LGB group. However, there were 37 late major complications in the LGB group and 74 in the LAGB group.
After adjusting for preoperative weight, the team found that the mean excess weight loss (EWL) at 3 months was 36% after LGB versus 15% after LAGB. At 6 months EWL was 52% in the LGB group and 23% in the LAGB group, at 12 months 67% and 33%, and at 18 months 75% and 40%.
Dr Laurent Biertho's team concluded, "LGB provides a higher EWL at 18 months, compared with LAGB…this holds for all ranges of preoperative BMI".
"Both procedures can produce an EWL above 50%, but this criterion is met faster after LGB".
"The best indication for the two procedures is still unclear and probably depends on the patient's preoperative BMI, eating habits, and associated morbidities".