GSATRIC BYPASS BESTS BANDING FOR WEIGHT LOSS , DIABETES, HIGH BLOOD PRESSURE AND 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 percent of their excess weight, compared to 45
percent 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 Southwestern.
According to a 2011
estimate, some 120,000 bariatric procedures are performed annually in the U.S.
Worldwide, gastric bypass accounts for about 47 percent of weight loss
procedures, while gastric bands account for about 18 percent.
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 percent) with hypertension reported remission after two years with gastric
bypass, compared to less than a fifth (17 percent) 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 percent of gastric
bypass patients reported remission in the studies, compared to about 23 percent
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 favored gastric bypass, through both were
relatively low -- less than 3 percent for bypass surgery and less than 5
percent for banding procedures.
The review focused
only on studies that followed patients for at least two years and in which more
than 80 percent of patients were successfully tracked during that time; 29
studies total. Most -- 97 percent -- of weight-loss surgery studies track only
a small percent 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
percent to be considered reliable.
They also 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
don't 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."
Gastric bypass, known
as Roux-en-Y (pronounced "roo-n-why") gastric bypass, is considered
the gold standard and one of the most commonly performed weight-loss
procedures. Surgeons create a smaller stomach pouch and reroute food to bypass
part of the small intestine. Gastric band procedures install an inflatable band
around a portion of the stomach that can be adjusted to limit food intake. With
both procedures, patients feel fuller more quickly, and therefore eat less and
consume fewer calories.
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