Gastric Bypass Surgery vs. Lap Band: Which is Better, Safer, More Effective?

Weight loss fast and for good? Get a bypass—it beats the band, a study shows: More than one billion of the world’s seven billion people are overweight and at least 300 million are clinically obese.

Having reached epidemic proportions globally, obesity is a major contributor to the global burden of chronic disease and disability, the World Health Organization says.

In the United States, Canada, the United Kingdom, Eastern Europe, the Middle East, the Pacific Islands, Australasia and China, obesity rates have risen three-fold or more since 1980, fueled by soaring consumption of more high-calorie, nutrient-poor, sugary and fatty foods, combined with reduced physical activity.

Obese people are at a much higher risk for serious diet-related chronic diseases—type 2 diabetes, cardiovascular or heart and blood vessel diseases, hypertension and stroke, and certain forms of cancer.

Obesity is no longer a problem of rich countries but also a growing crisis in poor countries, existing side-by-side with under-nutrition. It can lead to premature death, and a seriously lowered quality of life.

Bypass beats band
For morbidly obese people, weight-loss surgery is an option. Among these options, the gastric bypass comes with more complications shortly after surgery than gastric banding — but has fewer long-term side effects and repeat operations.

This is according to a new study that enlisted more than 400 obese Swiss patients, which was published on Jan. 17 in the Archives of Surgery.

People who got bypass surgery also lost weight faster, and more kept it off, the study also showed. Weight loss remained “significantly better” six years after gastric bypass compared with patients who received a gastric band, researchers said.

The Swiss study is one of the longest studies comparing the two common procedures. Both procedures work by making the stomach smaller and thus limiting the amount of food the stomach can hold.

A gastric band procedure involves placing a band around the top of the stomach to make it into a smaller pouch.

In contrast, patients who have a gastric bypass have their stomachs stapled off and then rerouted to bypass a segment of the small intestine. Either way, a patient’s stomachs is shrinked and the amount of food consumed and calories taken in drops significantly. About 200,000 Americans undergo surgical procedures to shrink their stomachs each year.

“What we would like with any of the (weight-loss) procedures ideally would be to have the least long-term complications, certainly the least long-term complications requiring (repeat) surgery,” said Dr. Michel Suter, a surgeon from the Hospital du Chablais, Aigle, Switzerland, who worked on the study.

He told Reuters Health, “There are drawbacks with bypass, there are side effects, and we have to take them into account…but overall, if I had to choose between the procedures, I certainly recommend the bypass.”

But another doctor who was not involved in the study said that when complications do happen with gastric bypass, they are often more serious than complications after banding.

1998 to 2005
For the study, Dr. Suter and his colleagues reviewed records of 442 obese patients who had undergone weight-loss surgery at Swiss hospitals between March 1998 and May 2005.

To qualify for surgery, patients had to have a body mass index (BMI) of at least 40, or at least 35 if they also had an obesity-related illness. The BMI is a measure of weight in relation to height. People with BMIs of 30 or higher are considered obese.

Half of the patients had gastric band procedures, while the other half underwent a gastric bypass. The two groups were similar in terms of their age and initial weight.

For the next six years after the surgeries, the researchers checked in with the study participants at least twice a year.

Patients who had a bypass experienced more complications in the month after the surgery than those who had had banding: 17 percent of bypass patients had any surgery-related problems, compared to five percent in the banding group—and this was typically an infection.

The study also measured weight loss by looking at group changes in BMI at various times after surgery. Participants started out with an average BMI of about 43. After a year, the average BMI in the bypass group fell below 30, while those receiving a gastric band had a BMI of about 34.

According to researchers, the maximum weight loss was achieved after an average of three years for the gastric-band patients compared with 18 months for the bypass group.

In addition, in patients who underwent gastric banding, total cholesterol remained unchanged. In patients who underwent gastric bypass, total cholesterol decreased.

The researchers also probed treatment failures—measured by a reversal of the procedures or patients who had a BMI of 35 six years after surgery. The findings? The failure rate for gastric banding was 48.3 percent compared with 12.3 percent for bypass.

Thirteen percent of patients needed re-operation after complications with gastric bypass. In contrast, close to 27 percent needed re-operation following banding.

Writing in their Archives of Surgery article, researchers reported that the long-term complications of gastric banding were generally related to the band eroding and needing to be removed, food intolerance or stretching of the esophagus.

With gastric bypass, patients most often had internal hernias, a type of bowel blockage that can be life threatening if not treated.

Initially, gastric banding seemed safer than gastric-bypass surgery in the first three months after the procedure, said Dr. Robin Blackstone, the president of the American Society for Metabolic and Bariatric Surgery. [via Wall Street Journal]

But the new findings from the long-term study on both procedures will help doctors determine better treatment choices for obese patients. “What’s important is how effective both procedures are,” she says.

Obese patients who don’t have underlying diseases like Type 2 diabetes or high blood pressure can be good candidates for gastric-banding procedures while heavier and sicker patients are more likely to benefit from gastric bypass, she added.

Complications not alike
For Dr. Christine Ren-Fielding, a weight-loss surgeon at the New York University School of Medicine, the study is like comparing apples to oranges. Dr. Ren-Fielding was not involved in the new study,

The surgeon told Reuters Health by email that her own research has suggested gastric bypass complications tend to be much more serious than complications related to banding.

“We all know that not all complications are alike, “she said. “For example a wound infection treated with antibiotics is not the same as a…leak which requires re-operation and extended hospitalization.”

What’s more, technique and surgeon experience can affect outcomes of any surgery, she added.

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