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SAGES 2013

Study: Bypass has less overall failure rates than band

Study suggests limitations of the long-term effectiveness of banding

Laparoscopic adjustable gastric banding has similar rates of procedure-related reoperation and significantly higher rates of weight loss failure compared to bypass, according to a study from researchers at Virginia Commonwealth University Medical Center, Richmond, VA.

The study also found that banding had more overall failure rates (defined as procedure-related reoperation and/or weight loss failure) than bypass. The authors of the study concluded, “While LAGB may be considered for well-informed and motivated patients, these data suggest that long-term effectiveness of LAGB might be limited.”

Although banding is considered by some to be a safer and as effective as laparoscopic gastric bypass, some published studies have questioned the long-term outcomes especially in terms of complication and failure rates.

The researchers decided to investigate whether patients who received a gastric band at their centre had higher rates of reoperation, weight loss failure, and overall failure, compared to bypass, at three and five year intervals.

They matched patients who underwent primary banding or bypass between 2004 and 2011 for age, gender, race, preoperative BMI, and the presence of hypertension, diabetes mellitus, obstructive sleep apnoea, and hyperlipidemia.

Outcomes included patient demographics, %EWL, BMI units lost, BMI at most recent follow-up, and rates of reoperation, weight loss failure (<50% EWL), and overall failure (procedure-related reoperation and/ or <50% EWL) at three and five years.

Outcomes

Five hundred and fifty six patients were match to each group (228 in each group). At three and five years, banding patients had a significantly lower %EWL (35 vs. 71 and 29.3 vs 66.7), lost fewer BMI units (7.4+0.6 vs 15+0.5 and 5.9+0.9 vs 14.6+1.1), and had a higher postoperative BMI (36,6+0.7 vs. 29+0.4 and 29.4+1.0, all p<0.05), compared to LRYGB.

With regards to complications, banding patients had a lower reoperation rate than bypass patients at three years but by five years the difference was not significant (6 vs 9 and 11 vs 11.5, p=NS). Rates of weight loss failure (percentage of patients who lost <50%) were also higher in the banding group (75 vs 10.5 and 81.5 vs 15.4) at the same period (p<0.05). This was also the case when weight loss failure was redefined as <25% EWL (31.3% vs. 1.5% at three years and 81.5% vs. 15.4% at five years, both p<0.01).

Over the study period, morbidity was higher among banding patients compared to bypass patients (19 vs. 12.7%, p=0.04), although procedure-related mortality was low for both banding (0%) and bypass (0.4%). 

Overall failure rates were higher after LAGB at all time points. Band-related complications included erosion (0.4%), port/band infection (0.4%), leak (0.9%), incisional hernia (0.9%), port inversion (0.9%), slippage (7%), and pouch/oesophageal enlargement (9.7%). Procedure-related complications after LRYGB were bleeding (1.7%), incisional hernia (2.6%), anastomotic leak (3.5%), and internal hernia (4.8%).

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