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Bypass vs banding

RYGB has more complications, greater weightloss vs. AGB

RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalisations

Gastric bypass surgery runs a higher risk of short-term complications compared with patients who underwent gastric banding, although bypass patients did experience greater weight loss, according to a study published in JAMA Surgery.

The study, conducted by Group Health Research Institute included 7,457 patients who had laparoscopic bariatric surgery from 2005 through to 2009. The researchers looked at Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) specifically and looked into the change in BMI, short-term complications within 30 days of the surgery, and subsequent hospitalisation and intervention. Of the 7,457 patients, 1,192 had AGB while 5,800 had RYGB.


The mean maximum BMI loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (p<0.001). In propensity score–adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; p=0.006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalisation were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; p<0.001), respectively (Figure 1).

Figure 1: Outcomes RYGB vs. AGB

The researchers concluded that in this large bariatric cohort from ten healthcare systems, they found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalisations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.

“This is important because more and more people are living with severe obesity and having bariatric surgery,” said Dr David Arterburn, an associate investigator at the Group Health Research Institute, a Group Health physician, and an affiliate associate professor of medicine at the University of Washington School of Medicine stated,  “They need to know what the potential pros and cons are—so they can have informed discussions with their doctors about which course suits them best, based on what matters most to them as individuals.”

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