Ten-year trial: bypass beats band

A trial designed to assess outcomes for patients receiving laparoscopic adjustable gastric banding (LAGB) vs. laparoscopic Roux–en-Y gastric bypass (LRYGB) has reported bypass has better weight loss and reduced number of failures, despite significantly longer operative time and life-threatening complications.

Presenting the outcomes at the ASMBS meeting in San Diego, Dr Luigi Angrisani and colleagues from the General and Laparoscopic Surgery Unit, San Giovanni Bosco Hospital, Napoli, Italy, said that this prospective, randomised clinical trial was established to provide much-needed data comparing the two most common bariatric procedures.

From January 2000 to November 2000, 51 patients aged 19 to 50 were randomly allocated into two groups. Group A consisted of 27 patients who received LAGB via pars-flaccida; the remaining 24 patients were allocated into group B and received standard LRYGB.

Baseline patient demographics revealed that the vast majority of LAGB patients were female (22 out of 27), had a mean age of 33.3 (range 21-52), a mean weight: of 120kg (range: 92-150kg), a mean BMI of 43.4 (range: 40.1-49.2); and a 83.8% excess weight (range 36.9-128.8).

Baseline patient demographics in the LRYGB showed the majority were female (20 out of 24), and had a mean age of 34.7 (range 20-50). Their mean weight was 120kg (range 95-147kg), a mean BMI 43.8 (range 40-48.9) and 83.3% excess weight (range 34.6-126.53).

Results

The operative time, re-operation with hospital stay, weight, BMI, and %EWL, were collected; procedures in the study were considered to have failed if BMI was over 35 at the endpoint. Data were analysed by Student t-test (p>0.05 is considered significant).

Mean operative time was 60 minutes for group A and 220 minutes for group B (p>0.001); no deaths were reported. Five LAGB patients and three LRYGBP patients were lost to follow-up.

The re-operation rate (p=ns) was 8/22 (36%) compared with 3/21 (14%). Hospital stay ranged from two to three days in group A and one week to six months in group B.

After ten years, the mean weight was 101±22 and 83±18kg, BMI was 36±7 and 30±5, mean %EWL was 46±27 and 69±29, with failure rate 7/14 (50%) and 4/21 (19%) in Group A and B respectively (p<0.001). Additionally, patients with BMI<30 were 3/14 (21%) and 10/21 (48%) in the same groups (p<0.001).

The researchers concluded that LRYGB produces better weight loss and fewer failures compared with LAGB, despite significantly longer operative time and life threatening complications.

However, the investigators noted that long-term nutritional sequalae of LRYGB are still unknown.