21st Century Weight Loss: Banding Versus Bypass

Stephen W Davies, MD, MPH, Christopher A Guidry, MD, MSc, Rachel I Penn, BA, Robert G Sawyer, MD, Bruce D Schirmer, MD, Peter T Hallowell, MD. University of Virginia School of Medicine.

 

Introduction:
The two most commonly performed procedures for bariatric surgery include Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB). While many studies have commented on short-term, postoperative outcomes of these procedures, few studies have reported long-term data. The purpose of this study was to compare long-term, postoperative outcomes between RYGB and AGB.

 

Methods:
This was a retrospective, cohort study comparing all patients undergoing either RYGB or AGB at our institution, from January 1998-August 2012. Patients were followed at 1-, 3-, and 5-year intervals. Categorical and continuous data were analyzed. Multivariable, linear regression was performed.

Results:
A total of 2,453 bariatric surgeries were performed at our institution from January 1998-August 2012. Two thousand four hundred twenty patients (380 AGB, 2040 RYGB) were identified by CPT code. Median (range) follow-up for patients was 3 (1-5) years. Preoperatively, RYGB patients were significantly younger, more obese, had higher hemoglobin A1c, and less often suffered from hypertension, dyslipidemia, and asthma as compared to AGB patients. Postoperatively, RYGB patients experienced significantly longer operating room times, higher incidences of intensive care unit admissions, longer hospital lengths of stay, and increased incidence of small bowel obstruction as compared to AGB patients. At 1-, 3-, and 5-year follow-up, RYGB patients weighed significantly less and experienced a significantly greater percentage of total body weight loss, lesser rate of gastroesophageal reflux disease, lesser rate of diabetes, and lesser rate of apnea as compared to AGB patients. After adjusting for statistically significant and clinically relevant factors (e.g., age, gender, body mass index, degenerative joint disease, diabetes, hypertension, dyslipidemia, heart disease, apnea, and asthma), RYGB was independently associated with a significantly greater percentage of total body weight loss as compared to AGB at 1-year (P<0.0001), 3-year (P<0.0001), and 5-year (P<0.0001) follow-up.

Conclusion:
Our results support previous studies that have observed a greater weight-loss associated with RYGB as compared to AGB and provide further evidence towards the long-term sustainability of this weight-loss. Additionally, RYGB appears to result in a greater reduction of medical comorbidity.

 

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