Gastric banding vs. gastric bypass: clinical outcomes at 5+ years follow up

Rod McKinlay, MD, Steven Simper, MD, Sherman Smith, MD, Fielding Dunn, PA. St. Mark’s Hospital.

Introduction: We compared medium to long-term clinical outcomes (>5 years) among the first 100 patients undergoing laparoscopic adjustable gastric banding (LAGB) and the first 100 patients undergoing laparoscopic gastric bypass (LGB) for a single fellowship trained surgeon in a private bariatric surgery practice.

Methods and procedures: Data were collected prospectively and reviewed retrospectively. LAGB was performed with the pars flaccida technique using the Allergan Lap-Band (r) system. LGB was performed with a retrocolic, antegastric technique with a handsewn gastrojejunostomy over a 36 Fr bougie. Band patients were seen with weight loss and complications recorded at monthly intervals for the first six months, then bi-monthly for six months, then every 6 months thereafter.  Bypass patients were seen with weight loss and complications recorded at 1 month, 2 months, 4 months, 8 months, and 1 year, and then annually thereafter.  Chi-squared test or Fisher exact test were used for categorical variables and Student’s t test for continuous variables.

Results: LAGB patients were slightly older (41 vs. 39 years, p<0.05) and less heavy than gastric bypass (BMI 44.2 vs. 46.1, p<0.05).  At a mean of 5.4 years of follow up, LAGB patients experienced an average of 49% excess weight loss (EWL) (SD 29%, mean BMI reduction 44.2 to 35.2); and LGB patients had 74% EWL (SD 21%, mean BMI reduction 46.1 to 30.7), p<0.0001 at a mean follow up of 6.2 years.  The complication rate among band patients was 10% at 2 years and 23% after 5 years, with 10 patients undergoing band removal, 4 of whom had revisions to other bariatric procedures.  The complication rate among bypass patients was 24% at three years and 28% at 6 years of follow up.  

Conclusions: LGB induces superior weight loss to LAGB at follow up of at least 5 years.  LAGB is associated with fewer complications at both 3 and 6 year intervals but has a higher rate of increasing complications with time, including band removal for complications or insufficient weight loss.

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