Brief Article
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World J Gastroenterol. Sep 28, 2013; 19(36): 6035-6043
Published online Sep 28, 2013. doi: 10.3748/wjg.v19.i36.6035
Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding
Nam Q Nguyen, Philip Game, Justin Bessell, Tamara L Debreceni, Melissa Neo, Carly M Burgstad, Pennie Taylor, Gary A Wittert
Nam Q Nguyen, Tamara L Debreceni, Melissa Neo, Carly M Burgstad, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
Nam Q Nguyen, Pennie Taylor, Gary A Wittert, Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5000, Australia
Philip Game, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
Justin Bessell, Adelaide Obesity Surgery, Calvary Wakefield Hospital, South Australia 5000, Australia
Justin Bessell, Department of Surgery, Flinders University, Bedford Park, South Australia 5042, Australia
Author contributions: Nguyen NQ and Wittert GA contributed to conception and design, drafting of the article; Game P and Bessell J contributed to performance of procedures; Nguyen NQ and Debreceni TL contributed to analysis and interpretation of the data; Nguyen NQ, Game P, Bessell J, Debreceni TL, Neo M, Burgstad CM, Taylor P and Wittert GA contributed to critical revision of the article for important intellectual content and final approval of the article; all the authors had made a significant intellectual contribution to this manuscript.
Correspondence to: Nam Q Nguyen, MBBS, FRACP, PhD, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. quoc.nguyen@health.sa.gov.au
Telephone: +61-8-82225207 Fax: +61-8-82225885
Received: January 7, 2013
Revised: June 3, 2013
Accepted: June 18, 2013
Published online: September 28, 2013
Processing time: 262 Days and 5.8 Hours
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/m2vs 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/m2vs -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; Gastric bypass; Gastric banding; Weight loss; Complications; Co-morbidity; Outcomes

Core tip: Roux-en-Y gastric bypass (RYGB) produces substantially greater weight loss and resolution of co-morbidities than laparoscopic adjustable gastric band (LAGB) in a community setting, in both the short- and long-term. Although peri-operative complications are higher with RYGB than LAGB, which are non-fatal and mostly related to wound infection, the long-term complication rate is higher after LAGB. Where LAGB fails to induce or maintain weight loss, RYGB appears to be the superior salvage procedure. The better outcomes for LAGB in males compared to females after 3 years post-surgery are intriguing and needs further confirmation.