Gastric bypass better than banding for weight loss, diabetes, high blood pressure, cholesterol control
Gastric bypass surgery has better outcomes than gastric banding for
long-term weight loss, controlling type 2 diabetes and high blood
pressure, and lowering cholesterol levels, according to a new review by
UT Southwestern Medical Center surgeons of nearly 30 long-term studies
comparing the two types of bariatric procedures. The review, appearing in JAMA, found
that those undergoing gastric bypass
operations lost more weight an average
of 66% of their excess weight, compared to
45% average excess weight loss for those
undergoing gastric banding procedures.
We know gastric bypass brings more
weight loss success and relief of commonly
associated illness versus gastric band at
one year after surgery. We now have the
best evidence available telling us this
outcome continues to be true even up to
five years after surgery.
We also know these
procedures maintain their safety profile
long-term, said Dr. Nancy Puzziferri,
Assistant Professor of Surgery and part
of the bariatric surgery team at UT
Worldwide, gastric bypass accounts for
about 47% of weight loss procedures, while
gastric bands account for about 18%.
Researchers found dramatic differences
between the two procedures in controlling
diabetes. More than two-thirds of gastric
bypass patients with Type 2 diabetes saw
remission of the disease, compared to less
than a third of gastric band patients.
Gastric bypass surgery also lowered
hypertension better than gastric banding.
Nearly half of patients (48%) with
hypertension reported remission after two
years with gastric bypass, compared to less
than a fifth (17%) for those undergoing
gastric band procedures.
Gastric bypass also improved hyperlipidemia, characterized by high levels of cholesterol, triglycerides, and
lipoproteins in the blood.
About 60% of
gastric bypass patients reported remission
in the studies, compared to about 23% of
gastric band patients.
The review underscores the importance
of thinking about durable treatments, as
obesity, type 2 diabetes, hypertension, and
elevated cholesterol are chronic illnesses,
rather than focusing on short-term results,
Dr. Puzziferri said.
Long-term complication rates for the
two procedures also favoured gastric
bypass, through both were relatively low
less than 3% for bypass surgery and less
than 5% for banding procedures.
The review focused only on studies that
followed patients for at least two years and
in which more than 80% of patients were
successfully tracked during that time; 29
Most 97% of weight-loss surgery studies track only a small
of patients and/or only for up to one year.
The researchers suggested more studies are
needed to look at long-term outcomes
at least two years past the initial surgery
while maintaining follow-up of at least
80% to be considered reliable.
concluded there were not a sufficient
number of studies meeting these criteria to
accurately assess gastric sleeve procedures.
It is also very important to understand
sleeve gastrectomy, which with the evidence
we have so far, appears to perform as well as
gastric bypass for weight loss. We just dont
have as much evidence, in quantity or
quality, as we have for the other procedures.
The evidence will come in time, Dr. Puzziferri said. We have not been doing
sleeve gastrectomies for as many years as we have been performing gastric bypass
or gastric band surgeries.
of upload: 14th Nov 2014