Weight Loss Surgery: Bar for Lap Band Lowered, but Is Gastric Bypass Better?

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On the heels of a Feb. 16 decision by the Food and Drug Administration to make millions more people eligible for laparoscopic gastric banding (lap band) weight loss surgery, a new study suggests the more invasive gastric bypass may be better.

Researchers from the University of California, San Francisco, compared the effects of lap band and gastric bypass among 200 morbidly obese patients treated at the UCSF Bariatric Surgery Program. Gastric bypass led to greater weight loss, increased resolution of diabetes and improved quality of life one year after surgery, they reported today in Archives of Surgery.

Complication rates were similar between the two procedures, but re-operation rates were lower for gastric bypass, leading the researchers to conclude that the risk-benefit profile for gastric bypass was superior.

But experts urge caution in interpreting the study's results, and stress that the varying benefits and risks of either procedure make the decision a personal one.

"If a patient's primary interest is to lose their diabetes, then gastric bypass is better. If the patient prefers slower weight loss, then banding is better," said Dr. Theodore Khalili, founder and director of the Khalili Center for Bariatric Care in Beverly Hills and former director of the Weight Loss Surgery Program Cedars-Sinai Medical Center. "Unless there is an absolute contraindication to one procedure, then we let the patient decide."

Roughly one-third of Americans are obese with a body-mass index over 30, and five percent are morbidly obese with a BMI over 40, according to the Centers for Disease Control and Prevention. The extra weight boosts the risk of type 2 diabetes, heart disease, stroke, cancer, and even death. While weight loss surgery can help obese people shed the extra pounds and some of the related health risks, the surgical risks and the cost (upwards of $20,000) make the decision not one to be taken lightly.

Battle of the Bulge-Fighters

With roughly 180,000 operations per year in the United States, gastric bypass is the most common weight loss surgery. The procedure physically shrinks the stomach and forces food to bypass part of the small intestine, causing people to feel fuller after eating less, and fewer calories to be absorbed.

But since its approval by the FDA in 2001, lap band surgery is picking up steam. Its use rose from 7 percent to 23 percent between 2004 and 2007, according to a 2009 study published in Surgery for Obesity and Related Diseases. Gastric bypass use rose from 53 percent to 66 percent during the same period.

Like gastric bypass, lap band makes the stomach smaller so people feel fuller. But it does not reroute food and cause fewer ingested calories to be absorbed, so the effects are slower.

"The lap band works over two to three years, while the maximum benefits of the gastric bypass surgery are at a year to year-and-a-half," Khalili said. "This study is not comparing apples to apples because the endpoint may be a little premature for the band," he said.

"Their results are not surprising given the fact that the follow-up was for only one year. If their five year follow-up demonstrates true superiority of gastric bypass then this paper might help change clinical practice," said Dr. Scott Belsley, director of robotic surgery at St. Luke's – Roosevelt Hospital in New York City.

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