Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

Abstract

Aim: To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).

Methods: Data relating to changes in body mass index (BMI) and procedural complications after RYGB (1995-2009; n = 609; 116M: 493F; 42.4 ± 0.4 years) or LAGB (2004-2009; n = 686; 131M: 555F; 37.2 ± 0.4 years) were extracted from prospective databases.

Results: Pre-operative BMI was higher in RYGB than LAGB patients (46.8 ± 7.1 kg/m² vs 40.4 ± 4.2 kg/m², P < 001); more patients with BMI < 35 kg/m² underwent LAGB than RYGB (17.1% vs 4.1%, P < 0.0001). BMI decrease was greater after RYGB. There were direct relationships between weight loss and pre-operative BMI (P < 0.001). Although there was no difference in weight loss between genders during the first 3-year post-surgery, male LAGB patients had greater BMI reduction than females (-8.2 ± 4.3 kg/m² vs -3.9 ± 1.9 kg/m², P = 0.02). Peri-operative complications occurred more frequently following RYGB than LAGB (8.0% vs 0.5%, P < 0.001); majority related to wound infection. LAGB had more long-term complications requiring corrective procedures than RYGB (8.9% vs 2.1%, P < 0.001). Conversion to RYGB resulted in greater BMI reduction (-9.5 ± 3.8 kg/m²) compared to removal and replacement of the band (-6.0 ± 3.0 kg/m²). Twelve months post-surgery, fasting glucose, total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.

Conclusion: RYGB produces substantially greater weight loss than LAGB. Whilst peri-operative complications are greater after RYGB, long-term complication rate is higher following LAGB.

Keywords: Bariatric surgery; Co-morbidity; Complications; Gastric banding; Gastric bypass; Outcomes; Weight loss.

Figure 1

Comparison of changes in the performance of different type of bariatric procedures over a 10-year period in Australia based on medical benefit schedule item number.

Figure 2

Flow chart of studied cohort in relation to clinical outcomes.

Figure 3

Changes in body mass index in patients who underwent Roux-en-Y gastric bypass and laparoscopic adjustable gastric band up to 5 years post-surgery. ^bP < 0.001 vs laparoscopic adjustable gastric band (LAGB). RYGB: Roux-en-Y gastric bypass.

Figure 4

Relationship between the degree of weight loss and presenting body mass index induce by Roux-en-Y gastric bypass and laparoscopic adjustable gastric band procedure. ^bP < 0.001 vs laparoscopic adjustable gastric band (LAGB). RYGB: Roux-en-Y gastric bypass; BMI: Body mass index.

Figure 5

Outcomes of patients who had complications with laparoscopic adjustable gastric band requiring further interventions, including removal of band, removal and placement of band, replacement of port only and conversion to Roux-en-Y gastric bypass. RYGB: Roux-en-Y gastric bypass; LB: Lap-band; BMI: Body mass index.

Figure 6

Body mass index changes after Roux-en-Y gastric bypass and laparoscopic adjustable gastric band in male and female 3 years post-surgery. ^aP = 0.02 vs female. RYGB: Roux-en-Y gastric bypass; LAGB: Laparoscopic adjustable gastric band.