SAN DIEGO – Laparoscopic Roux-en-Y gastric bypass produced long-term weight loss results that were statistically superior to those of laparoscopic adjustable gastric banding, based on 10-years’ follow-up in a prospective randomized study.
Dr. Luigi Angrisani and his colleagues compared 10-year outcomes in 27 patients who underwent the Lap-Band via pars flaccida (group A) vs. those in 24 patients who underwent laparoscopic Roux-en-Y gastric bypass (group B) at San Giovanni Bosco Hospital, Naples, Italy, from January to November 2000.
Patients were included in the study if they had a body mass index (BMI) greater than 35 but less than 50 kg/m2, if they were older than age 19 years but younger than age 50, and if they lacked a hiatal hernia and had no previous abdominal surgery, Dr. Angrisani said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
At baseline, the mean age of patients was 34 years, their mean BMI was 44, their mean percentage of excess weight was 83%, and their mean weight was 118 kg.
Dr. Angrisani, who directs the general and laparoscopic surgery unit at San Giovanni Bosco Hospital, reported that the mean operative times were 60 minutes for group A and 220 minutes for group B (P greater than.001). There was no mortality, but five patients in group A and three in group B were lost to follow-up. The rate of reoperation was 41% in group A and 29% in group B.
After 10 years, the mean weight of patients in group A and B was 101 kg and 83 kg, respectively, their mean BMI was 37 vs. 30, and their mean loss of excess body weight was 46% vs. 69% (all P less than .05).
Reported compliance with the intake of multivitamins among patients in group B decreased over time. Compliance was 80% at 3 years, 66% at 5 years, 50% at 7 years, and just 33% at 10 years.
"Surgical complications in gastric bypass patients were life threatening, and long-term nutritional consequences remain to be defined, such as low compliance to vitamin supplementation," Dr. Angrisani said.
In his practice, potential candidates for gastric banding include "young and motivated" patients with a BMI of 40 or less; adolescents regardless of BMI; patients with BMI of 35 or less; high-risk patients, and those fearful of more-invasive procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass.
Dr. Angrisani said that he had no relevant financial conflicts to disclose.