Gastric Banding or Bypass? Comparing the Scientific Studies on Weight Loss Surgery

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A recent report in the American Journal of Medicine by University of California medical researchers compares the two most common weight loss surgeries: gastric bypass and gastric banding.

As weight loss surgery is becoming increasingly common, and research piles up indicating that it’s the most effective treatment for severe obesity, questions about the effectiveness and safety of various procedures become more important. While gastric bypass (also called Roux-en-Y) has been the primary type of bariatric surgery, in recent years the gastric banding procedure (also known as lap band) has grown in popularity, being seen as safer and potentially reversible.

The University of California researchers reviewed 14 comparative studies that examined the risks and benefits of these two surgeries and analyzed the results to conclude that gastric bypass is more effective in terms of weight loss and other health benefits.

Banding and Bypass Compared

The adjustable gastric band procedure (usually performed laparoscopically, which is why it’s commonly called a “lap band”) creates a smaller stomach pouch by putting a silicone band around the stomach. This smaller stomach pouch makes you feel full faster, which is why patients are able to lose weight more successfully after surgery. The gastric band can be adjusted or even removed—one reason this surgery has been increasing in popularity.

The gastric bypass procedure also creates a smaller stomach pouch, but this is done by actually resecting (surgically cutting and stitching) a part of the stomach; the “bypass” part comes in when surgeons make a direct connection between this new smaller stomach and the small intestine, so that food doesn’t pass through a part of the small intestine. So gastric bypass works to help patients lose weight in two ways: by helping you feel full faster and by letting the body absorb less nutrition from the food you do eat.

What the University of California Study Found

By comparing the available data on the two procedures, the researchers from the University of California concluded that gastric bypass produces better results in terms of weight loss and other health benefits. After one year, on average, patients who had the Roux-en-Y gastric bypass surgery had lost 26% more weight than the patients who had the lap band procedure.

The findings suggest that more patients would be cured of obesity-associated comorbidities, such as obstructive sleep apnea, hypertension and diabetes if treated with Roux-en-Y gastric bypass rather than laparoscopic adjustable gastric banding. In addition, patients who underwent Roux-en-Y appeared more satisfied than those who underwent the lap band procedure.

What about complications from the surgery? One of the reasons lap banding has grown in popularity is the perception that it is safer. The California study did find that lap banding had a lower rate of complications during the first thirty days after surgery, but for long term complications, the rates were about the same. And patients who had lap banding were more likely to require a second surgery.

Lap banding is probably appealing to surgeons because it is faster to perform and requires a shorter hospital stay, so that they could treat more patients. That’s certainly something to think about if you’re considering either gastric bypass or gastric banding. The study concluded that “until trials demonstrate the advantages of laparoscopic adjustable gastric banding in clearly defined subgroups of patients, Roux-en-Y gastric bypass should remain the bariatric procedure of choice in the United
States.”

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