January 24, 2012 in Blog Update by Damon

ARTICLE: Roux-en-Y Gastric Bypass Superior to Gasric Banding

From Medscape Medical News

By: Joe Barber Jr, PhD

January 18, 2012 — Roux-en-Y gastric bypass (RYGBP) provides superior, more rapid weight loss than gastric banding (GB) and results in lower long-term complication and comorbidity rates, although it is associated with a higher early morbidity rate, according to the findings of a case-matched study.

Sébastien Romy, MD, from Centre Hospitalier Universitaire Vaudois, in Lausanne, Switzerland, and colleagues published their findings online January 16 in the Archives of Surgery.

The authors note that bariatric procedures remain an issue of contention. “Controversy about bariatric procedures has been ongoing,” the authors write. “For patients with body mass index (BMI) less than 50 (calculated as the weight in kilograms divided by the height in meters squared), it lies mostly between purely restrictive procedures (GB and vertical banded gastroplasty) and restrictive/malabsorptive procedures (RYGBP) also acting by hormone-mediated mechanisms influencing hunger and satiety.”

The investigators enrolled patients with a BMI of more than 40 kg/m², or more than 35 kg/m² with at least 1 severe comorbidity, all of whom had failed conservative therapy and undergone a complete evaluation by a multidisciplinary team. The authors compared outcomes for 221 patients who had undergone GB with an equal number of patients who had undergone RYGBP. Patients were matched according to age, sex, and initial BMI.

Among eligible patients, maximal weight loss was achieved a mean of 18 months after RYGBP compared with 36 months after GB (P < .01). The maximal percentage of excess weight loss was significantly higher after RYGBP (78.5%) than after GB (64.8%; P < .001).

A significantly greater percentage of patients in the GB group had a BMI of more than 35 kg/m² after 3 (22.3% vs 6.9%, P < .001) and 6 (33.5% vs 12.3%; P < .001) years.

There were higher rates of early complication (17.2% vs 5.4%; P < .001) after RYGBP than after GB and a non-significant trend toward higher major morbidity (3.6% vs 2.2%; P = .54). However, the rates of long-term complication (41.6% vs 19%; P < .001) and failure (defined as a percentage of excess weight loss < 25%) or need for reversal/conversion (18.2% vs 0%; P < .001) were significantly higher in the GB group.

The authors conclude that RYGBP appears superior to GB based on their findings but that further studies are needed to confirm the results. “These results should ideally be confirmed by a large randomized study with long follow-up,” the authors write. “Ethical considerations might prevent potential investigators, however, from setting up a study where one treatment arm seems to be clearly inferior to the other and where the lack of equipoise makes patient information and accrual difficult if not impossible.”

In an invited critique, Jacques Himpens, MD, from St. Pierre University Hospital in Brussels, Belgium, agrees that RYGBP is superior to GB, but cautions that some issues remain to be settled. “A growing number of patients have problems linked with glucose metabolism like neuroglycopenia and diabetes recurrence late after RYGBP,” Dr. Himpens writes. “The exact origin of this evolution appearing several years after RYGBP remains unclear, but it is a source of increasing concern.”

Dr. Himpens is a consultant with Ethicon Endosurgery and Covidien and organizes workshops for Gore. The authors have disclosed no relevant financial relationships.

Arch Surg. Published online January 16, 2012. Abstract, Editorial