Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results
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Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity, but few studies have compared LRYGB and LAGB. All patients who underwent LRYGB and LAGB by a single surgeon at Legacy Health System were identified from a prospectively maintained database. Preoperatively, most patients were allowed to choose between LRYGB and LAGB. Age, sex, body mass index (BMI), complications, mortality, and weight loss were examined. From October 2000 to November 2003, 219 patients underwent LRYGB and 154 patients underwent LAGB. Mean preoperative BMI was 49.5+/-6.6 and 50.9+/-9.4 kg/m2, respectively (P=0.10). Mean age was 42+/-9 and 47+/-11 years (P<0.001). The LAGB group had a higher proportion of male patients (21% versus 7%, P<0.001). Patients undergoing LRYGB had longer operative times (134 versus 76 minutes, P<0.001), more blood loss (43 versus 28 ml, P<0.01), and longer hospital stays (2.6 versus 1.3 days, P<0.001). Excess weight loss was 35% for LRYGB versus 19% for LAGB at 3-month follow-up (P<0.001), 49% versus 25% at 6 months (P<0.001), 64% versus 36% at 12 months (P<0.001), 70% versus 45% at 24 months (P<0.001), and 60% versus 57% at 36 months (P=0.85). Major complications occurred in 7% and 6% (P=0.58) and minor complications occurred in 18% and 20% (P=0.65) of patients, respectively. Reoperation occurred in 21 patients (10%) after LRYGB and 31 (20%) patients after LAGB (P<0.01). Of patients undergoing reoperation, eight (38%) LRYGB patients and one (3%) LAGB patient required open laparotomy. One death occurred in each group. Patients undergoing laparoscopic adjustable gastric banding have shorter operative times, less blood loss, and shorter hospital stays compared with laparoscopic gastric bypass patients. The incidence of major and minor complications is similar; however, morbidity after LRYGB is potentially greater and the reoperation rate is higher in the LAGB group. Early weight loss is greater with gastric bypass, but the difference appears to diminish over time.
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