February 22, 2011

Gastric Bypass Exceeds Lap-Band In Long-term Outcomes

People who undergo gastric bypass surgery enjoy better long-term health outcomes -- including greater weight loss, resolution of diabetes and improved quality of life -- than those treated with Allergan Inc.'s Lap-Band device, according to two reports published in the February issue of Archives of Surgery.

"It's a dramatic difference," said Dr. Guilherme Campos of the University of Wisconsin School of Medicine in Madison, lead author of one of the studies.

Complication rates for the two most popular weight-loss procedures were about the same.

"Obesity and type 2 diabetes mellitus are currently two of the most common chronic, debilitating diseases in Western countries," wrote the researchers in a background article.

The laparoscopic Roux-en-Y gastric bypass, more commonly referred to as gastric bypass surgery, is the most common surgical procedure for treating diabetes in the United States. In 2001, the laparoscopic adjustable gastric band, or Lap-Band, was introduced as a less invasive alternative. 

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, Dr. Campos and colleagues examined 100 morbidly obese patients with a body mass index (BMI) greater than 40 who underwent Lap-Band surgery. These patients were matched by sex, race, age and initial BMI with 100 patients who underwent gastric bypass surgery.

The analysis showed that all weight loss outcomes were significantly greater for patients who had undergone gastric bypass, with an average excess weight loss of 64 percent for this group, compared with just 36 percent for Lap-Band patients.

Furthermore, 86 patients in the gastric bypass group successfully lost more than 40 percent of their excess weight, compared with 31 percent of lap-band patients.

Each group of participants had 34 patients with type 2 diabetes mellitus, with resolution or improvement significantly better among those who had undergone gastric bypass (26 patients or 76 percent) compared with those who received the Lap-Band surgery (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 17 percent in the Lap-Band 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.

And while 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), the rate of re-operation was higher among the Lap-Band patients (12 patients or 13 percent) compared with the 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 study's authors concluded.

"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."

In a second study, Dr. Wei-Jei Lee of the Min-Sheng General Hospital, Taiwan, Republic of China, and colleagues conducted a double-blind randomized controlled trial of 60 moderately obese patients (BMI between 25 and 35) between the ages of 30 and 60, all of whom had poorly controlled type 2 diabetes after conventional treatment.

Between September 2007 and June 2008, half of the patients were randomized to undergo gastric bypass with duodenum exclusion (bypassing the first 12 inches of the small intestine), while the other half were randomized to have a sleeve gastrectomy without duodenum exclusion.

Overall, 42 patients (70 percent) had remission of type 2 diabetes one year after surgery. However, this resolution was significantly greater for gastric bypass patients (28 patients or 93 percent) than among the sleeve gastrectomy patients (14 patients or 47 percent).

Both groups also had significant weight loss at the one- and three-month post-surgery follow-up, but gastric bypass patients had better weight loss results at the six- and 12-month follow-ups.

In addition to greater weight loss, patients who underwent gastric-bypass achieved a lower waist circumference and had lower glucose HbA1c and blood lipid levels than patients in the sleeve gastrectomy group.

Late complications occurred in two patients (3 percent), one patient in each group, and required hospitalization for treatment, but no major adverse events were observed.

"Although more clinical trials are needed, this study and other previous studies have strongly recommended that laparoscopic gastric bypass as a metabolic surgery should be included in the armament of diabetes mellitus treatments in less obese populations (BMI of 25-35) and in the morbidly obese population (BMI greater than 35)," the authors wrote.

The two studies were reported in the February issue of the journal Archives of Surgery.


Image Caption: Graphic of a gastric bypass using a Roux-en-Y anastomosis. Credit: Ethicon Endosurgery, Inc./Wikipedia  


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