Wednesday, January 18, 2012

Gastric Bypasses Destroy Lap-bands in Head to Head Study!


While this wasn't a randomized or blinded trial, the results were striking.

442 case-matched patients were followed for 6 post-operative years. Half received a gastric bypass, and half a gastric band.

While early minor complications were higher in the gastric bypass group (triple the rate seen in banding), major complications were similar. Aside from that, it's all bypass with the bypassed patients enjoying quicker losses, larger maximal losses and significantly better maintenance of losses.

How much better?

After 6 years, for every failed gastric bypass, there were 4 failed lap bands (with failure determined by BMI greater than 35 or reversal of the procedure). For every 1 long-term bypass complication there were 2 lap band complications, and for every 1 re-operation of a bypassed patient, there were 2 of lap banded ones.

Given how damning these results were, the journal invited noted band surgeon Jacques Himpens from Brussels to try to provide some balance in an after article commentary.

Dr. Himpens critiques?
  • The study could have used surgeons known to be leading experts in banding and bypass.
  • The mechanistic failing of banding to impact on weight related gut peptides might turn out to be an advantage in the very long term.
  • The band is more readily reversible.
Of course Dr. Himpens also clearly stated that he himself agrees gastric bypass is a "better" procedure than gastric banding.

Seems like the decision of which surgery to have just became a great deal clearer for those who are considering one.

Romy, S., Donadini, A., Giusti, V., & Suter, M. (2012). Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity: A Case-Matched Study of 442 Patients Archives of Surgery DOI: 10.1001/archsurg.2011.1708

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14 comments:

  1. Great post as always!

    I must be abnormal with my results with the band. I love my band :) 115 lbs GONE for over a year now.

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    1. Hey Lap Band Gal,

      Glad you're rocking your band. No doubt, many will, just it would seem, statistically fewer than those with RNYs.

      Best,
      Yoni

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    2. Anonymous2:16 pm

      I lost 115 pounds with the band as well, but over time it just kept tightening up to the point I couldn't even keep water down. I'm five years out and have regained 54 pounds! I now have no saline in my band and am having it removed. It is good short term, but it is definately not the best surgery for many in the long term. Congrats to you!!

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  2. I'd just like to point out that there are other options when it comes to Weight Loss Surgery - and while I get the title of the post is because the study Dr Freedhoff is talking about only compared LapBand and Gastric Bypass, there are 2 other surgeries out there as well, one of which has arguably better statistics than even the Gastric Bypass (though I'm biased I'll admit, plus I haven't diligently read the research in a couple of years since I got surgery). The other 2 surgeries that people should research and consider are calles Vertical Sleeve Gastrectomy (VSG) and Duodenal Switch (DS).

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  3. Anonymous11:32 pm

    Consider the difference between a 'bad outcome' with the various surgeries. A bad outcome for the lapband is , 'still obese' a bad outcome for gastric bypass/ RNY might be 'still obese AND permanently disabled'. The lapband is less effective , and always will be in such studies, because it requires greater commitment on the part of the patient. Basing the choice on this type of study , solely on the outcome of weight loss after a period of time, is dangerously flawed .

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    Replies
    1. Actuallly a bad outcome for lapband is not just less weight loss, the complication rate is what is being referred to in his article and there is quite a long list of potential (and some likely) complications that can be quite debilitating. Besides that I would argue that obesity in itself can be incredibly debiltating and create permanent disability.

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  4. Band bashing again. I know I'm 3 years out from banding, no longer obese and no complications so far. Even if I should have a complication, I'm very pleased with my results. RnY was not a consideration for me with my other health issues. Sleeve wasn't being done in my area at the time and DS is like RnY.. contraindicated for me. So, banding it was. And it's been a God-send.

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    Replies
    1. Lisa,

      Reporting peer reviewed study data isn't bashing.

      I'm glad you're rocking your band.

      The fact that you are though, doesn't mean that people who are considering banding shouldn't also be informed as to what the medical literature is saying about risks and benefits.

      People read through their own lenses - and yours is a successful banding. You'll be happy then to hear, a band surgeon will be doing a guest post next week about this very study.

      Delete
  5. Anonymous1:51 pm

    I can tell you I have had the band for just over two years. I lost 40 lbs that I do not contribute to the band. I worked very hard. The band had done nothing but make me physically ill every day. I started having complications in the last four months and gained all the weight back quickly. I am switching to gastric bypass in April. I have been miserable the entire time I have had the band and have ended up in the emergency room multiple times. I would never wish the hell of the band on anyone.

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  6. Anonymous8:41 am

    lap band girl No, your Not abnormal, but 1yr post band IS NOT long term, let's talk IF/When you get to 5 yrs .Complications Can/Do occur with any WLS but if someone is looking for long term results, it's NOT going to happen with an adjustable Gastric band, SO WHY bother having 2 Surgeries IF you can have 1. Even Allergan states the Complications ( had to in order to get it passed by FDA) those aren't just "maybe this will happen, They DO happen at a higher % rate than reported. Medically Induced Bulimia should also be on that list, Oh Wait, it is Vomiting....hope you have insurance If you need that band removed;)

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  7. Wow!!! For someone contemplating have either surgery you are all very scary reads! I will agree that obesity in itself is debilitating. One cannot exercise without pain or fear of hurting oneself . These posts make me want to take the chance of just exercising and blowing a knee.

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  8. I have had my band for four years now. I lost a lot of weight the last two fills were my demise. Acid reflex all the time vommiting ... Only ate 4 bites if food ... My band coming out my doctor suggested gastric bypass.. Unsure yet .. Happy to eat healthy foods that i havent in four long years... Broccoli cauliflower fruits omg heaven now ...

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    Replies
    1. I am in the same boat- either band way to loose or way to tight. In the process of figuring out what next step is.

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  9. Anonymous2:36 pm

    I got my band in January and now 6 months later have not lost weight had only two fills so far and they did not seem to help waiting to see a doctor because of pain on the port area, I am sorry that I spend all this money for no results, maybe should of had the sleeve surgery.:(

    ReplyDelete