Bypassing stomach may be best obesity surgery

With keyhole, or "laparoscopic" surgery, doctors can either bypass the stomach or place a constricting band around it to achieve weight loss in severely overweight patients. Now, new research suggests that the bypass operation provides better weight loss and offers other advantages over the banding procedure.

With gastric bypass, a piece of intestine is connected to the stomach so that swallowed food misses most of the stomach. In contrast, gastric banding involves the placement of a plastic band that reduces the size of the stomach.

Gastric bypass tends to be favored in the US, while surgeons in Europe generally prefer gastric banding, Dr. Markus Weber, from University Hospital Zurich in Switzerland, and colleagues note in the Annals of Surgery. While banding is easier to learn and less invasive, it is associated with long-term problems, such as slippage of the band or erosion.

Prior to June 2000, Weber's team preferentially performed laparoscopic banding procedures, after which they progressively switched to laparoscopic gastric bypass. For their current study, they compared outcomes of 103 patients who underwent gastric bypass with those of 103 patients who underwent gastric banding.

Complications within 30 days of surgery occurred in 21 patients in the bypass group and 18 in the banding group. However, in the long-term, 45 patients in the banding group experienced problems compared with just 14 in the bypass group. Moreover, repeat operations were nearly three times more common in the banding group and often involved performing a bypass.

As noted, the bypass operation produced greater weight loss than the banding procedure. In addition, weight-related problems, such as diabetes and high blood pressure, were more likely to improve with gastric bypass.

"In our hands, laparoscopic...gastric bypass is superior to laparoscopic gastric banding," Weber's team concludes.

SOURCE: Annals of Surgery, December 2004.