Feb 22, 2011

The gastric bypass is superior to the gastric banding in the treatment of diabetes

Surgery to treat obesity is becoming more and more common in today’s society. The two most popular surgeries are laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LB). There have been minimal studies done on the two, comparing outcomes of patients, but a recent study released in the Archives of Surgery has done just that. Researchers analyzed two groups of patients. The first group of patients was morbidly obese and treated with LB; the second group of morbidly obese patients was treated with RYGB. The patients were pair-matched by sex, race, age, initial body mass index, and presence of type 2 diabetes.

"With gastric banding," explains the University of California, San Diego, Center for the Treatment of Obesity (UC/SD-CTO), "an inflatable band is placed around the upper part of the stomach, creating a smaller stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result of gastric banding surgery, a patient achieves sustained weight loss by limiting food intake, reducing appetite, and slowing digestion."

"Gastric bypass is a combination procedure that limits the amount of food that you can eat and digest," the UC/SD-CTO says. "The most common gastric bypass surgery is called the Roux-en-Y gastric bypass. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The resulting pouch is only about the size of a walnut and can hold about one ounce of food. After the pouch has been created, most of the stomach and part of the intestines are bypassed by attaching (usually stapling) a part of the intestine to the small stomach pouch. As a result, a gastric bypass patient cannot eat as much and absorbs fewer nutrients and calories."

Researchers compared perioperative and postoperative complications of participants in the two groups. Additionally, they compared reoperations and one-year outcomes of the surgeries, which included not only weight lost by the patients, but type 2 diabetes resolution and quality of life, as well.

The scientists were able to analyze the one-year outcomes for 93 LB patients and 92 RYGB patients. Overall, 11 patients in the LB group had complications, while 14 had complications in the RYGB group. The RYGB group had a higher rate of early (less than 30 days) complications, with 11 as compared to 2 of the LB patients. The rate of reoperations was higher for LB patients, however, with 12 as opposed to only two of the RYGB patients. And, RYGB patients had better results for weight loss (64 percent v. 36 percent), type 2 diabetes resolution (26 v. 17 patients) and quality of life measures.

"When performed in high-volume centers by expert surgeons," study authors concluded, "RYGB has a similar rate of overall complications and lower rate of reoperations than LB. With the benefit of greater weight loss, increased resolution of diabetes, and improved quality of life, RYGB, in these circumstances, has a better risk-benefit profile than LB."

Photo: MedPath Group
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