Stomach bypass operation best for extreme obesity

Although technically more challenging, laparoscopic Roux-en-Y gastric bypass, a common type of stomach bypass operation, provides greater weight loss in severely obese patients than does placing a plastic band around the stomach to make it smaller, new research shows.

Stomach bypass is also more likely than banding to promote the resolution of diseases often seen in obese patients, such as high blood pressure and diabetes.

Although multiple trials have compared the two procedures, this is the first study to focus specifically on patients with a BMI greater than 50 - with super morbid obesity - Dr. George Ferzli and his associates report in their article, published in the Archives of Surgery.

BMI is a measure of body weight for height. Values between 20 and 25 are typically considered normal. Any value of 30 or greater is considered obese.

This information is vital for patients considering weight loss surgery, Ferzli told Reuters Health, "because proper patient and procedure selection, proper follow-up, and proper long-term support are quite important in achieving the desired outcome."

At the SUNY-Health Science Center of Brooklyn in Staten Island, New York, patients undergoing weight loss surgery decided which procedure would be performed, after receiving extensive counseling. To be eligible, the patients had to complete a supervised dietary and exercise program of 8 to 12 months without maintaining weight loss.

Ferzli performed more than 315 weight loss procedures between February 2001 and June 2004. Among 106 super morbidly obese patients, 60 underwent stomach banding and 46 underwent stomach bypass.

Stomach bypass took longer perform in the OR than did stomach banding. Moreover, patients treated with stomach bypass were hospitalized for a day or two longer. There were no differences between the operations in the rate of early complications.

After 30 days, however, patients treated with stomach bypass had fewer complications than those treated with banding and also lost more weight.

"We believe that the band requires significant will and discipline and compliance, otherwise the patient can get things by the restricted area, especially high-calorie liquids," Ferzli noted. Complications are likely to result from patients "not eating properly, trying to force things down by eat rapidly or not chewing properly."

"In our experience, laparoscopic Roux-en-Y gastric bypass appears superior to laparoscopic adjustable gastric banding in super morbidly obese patients," Ferzli and his associates conclude in their paper.

There is a subset of severely obese patients for whom gastric band would be more appropriate, Ferzli added. "We now reserve gastric banding to patients who cannot have gastric bypass surgery, because of such conditions as liver disease or (stomach disease) and ulceration that require frequent endoscopy."