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Gastric Bypass or Gastric Banding: What Really Is The Better Bariatric Surgery For Extreme Weight Loss

There are two popular kinds of bariatric surgery:

  • Gastric banding
  • Gastric bypass

According to a study on the two, the Roux-en-Y gastric bypass has been linked to better weight loss and improvement in comorbidities than the gastric banding. The study also suggests that gastric banding has long-term complications and high reoperation rates than the other. However, the gastric bypass has a high rate of quick complications. Based on information from the study in the Archives of Surgery online edition on Jan. 16, it would seem that the gastric bypass is better than the gastric banding.

Of course, researchers based this decision on the study’s data. However, it’s really imperative to ponder the study’s design and other factors that are involved with the weight loss surgeries before any statement can be made concrete.

What The Switzerland Study Showed

In the study, there were more than 440 Switzerland patients who had a body mass index of at least 40 and no more than 50. Now, this was a matched-pair design kind of study. Patients choosing the gastric bypass were situated together based on sex, age and BMI to the patients who choose the gastric band. Gastric band patients who had no match were not included in the study. The same surgeon performed all surgeries by laparoscopically between March 1998 and May 2005.

92.3 percent of the patients were followed up on for six years, which allowed researchers to note the subsequent conclusions.

  1. Weight loss was seen quicker in the gastric bypass with an average of 18 months compared to the average of 36 months with the gastric banding.
  2. Excessive weight loss was higher after the gastric bypass than with the gastric banding (or 78.5 percent to 64.8 percent)
  3. Less long-term complications with the gastric bypass than with gastric banding (or 19 percent to 41.6 percent)
  4. Early complication rates higher with gastric bypass than with gastric banding (or 17.2 percent to 5.4 percent)
  5. Reoperations were higher with gastric banding than with gastric bypass (or 26.7 percent to 12.7 percent)
  6. Improvement in comorbidities after the gastric bypass


Bariatric Surgeons Offer Insights Into Study Findings

To well-known and highly respected bariatric surgeons offer their insights on the study’s findings:

Dr. Jacques Himpens of Brussels’ Saint Pierre University Hospital said he agreed with the findings. However, noted that before conclusions could be made, there were a few remaining cautions to be considered. He mentioned the bias possibilities in the case-control studies compared to the randomized trials as well as a potential study of matched patients to different surgeons in two centers (instead of one). Both could offer better evidence based on the surgeon’s proficiency and procedure preference. He said noted that the key advantage to gastric banding is that it is indeed reversible.

Dr. John Morton, MPH, a Stanford Hospital & Clinics director of bariatric surgery and associate professor of surgery, said the findings should be lightly taken because the trials were not done indiscriminately. He said the findings of the study were important but randomized trials comparing the two would provide a much clearer picture. However, funding for them isn’t available so people must rely on the comparative studies to get the “answers”.

The study does provide some interesting, and important, data and insight. However, it’s impossible to come up with a precise comparison based on only the one study. There are a number of variables with weight loss surgery such as surgeon proficiency and patient selection. All these must be considered before undergoing any weight loss procedure.