ASMBS: Laparoscopic adjustable gastric banding less effective than gastric bypass and sleeve gastrectomy

Dallas, TX

Patients who underwent laparoscopic adjustable gastric banding achieved less weight loss and less improvement in comorbid conditions than those who had gastric bypass or sleeve gastrectomy.

Slightly more than half of gastric banding patients lost more than 50% of excess weight after five years compared with more than 90% of patients who underwent laparoscopic Roux-en-Y gastric bypass, Diego Awruch, MD, reported at the American Society of Metabolic and Bariatric Surgery.

Surgical failure, defined as less than 50% excess weight loss, was almost six times more common with gastric banding.

"Laparoscopic adjustable gastric banding was associated with fewer complications, but the percent weight loss at one and five years was inferior to laparoscopic Roux-en-Y gastric bypass," said Dr. Awruch, of Pontificia Universidad Catolica in Santiago, Chile.

"Surgical failure occurred in more than 40% of patients who underwent gastric banding, and 16% of the patients required surgical revision of the initial procedure," he said.

Similar disparities in weight loss occurred in the comparison of gastric banding and sleeve gastrectomy.

Across the entire range of body mass index (BMI), laparoscopic sleeve gastrectomy led to greater weight loss, said David Schumacher, MD, of Wright State University in Kettering, Ohio.

Dr. Awruch reported outcomes for 91 patients treated with laparoscopic Roux-en-Y surgery and 62 who underwent gastric banding from 2001 to 2003.

Five-year follow-up was available for 73.6% of the gastric bypass patients and 91.5% of the gastric banding patients.

Comparison of baseline characteristics showed that bypass patients weighed significantly more (106.4 versus 97.6 kg, P<0.001) and had a significantly higher BMI (39 versus 35, P<0.001).

Gastric bypass was associated with a higher rate of early complications (14.2% versus 1.6%, P=0.009). In addition, nine bypass patients required reoperation or endoscopic dilatation compared with one patient in the banding group.

Late complications occurred in 37.3% of bypass patients compared with 27.4% of gastric banding patients, but the difference did not reach statistical significance. A higher proportion of gastric banding patients required reintervention (23 of 62 versus 20 of 91).

Percent weight loss at five years averaged 92.9% with gastric bypass compared with 59.1% with gastric banding (P<0.001).

Dyslipidemia, insulin resistance, hypertension, and type 2 diabetes improved or resolved in 80% to 100% of bypass patients compared with 20% to 40% of the gastric banding group.

At five years, 94% of bypass patients and 54.4% of gastric banding patients had maintained >50% excess weight loss.

Dr. Schumacher reported outcome data for 104 patients who underwent laparoscopic sleeve gastrectomy and 227 who had gastric banding from January 2006 through August 2008. Follow-up data were 99% as of January 2009.

Among patients followed for at least 18 months (about half of the total), weight loss averaged 133.82 lb in the sleeve group versus 58.93 lb in the banding group.

For the same time interval, excess weight loss averaged 55.54% with sleeve gastrectomy versus 38.65% with banding.

Stratification of patients by baseline BMI showed that sleeve patients had a greater excess weight loss in patients with BMI more than 50 (50% versus 33%), 40 to 49 (68% versus 40%), and less than 40 (90% versus 43%).

Readmission rates were 6% of sleeve gastrectomy patients and 1.3% with gastric banding. One patient (0.96%) in the sleeve group required reoperation compared with 19 (8.4%) gastric banding patients.

"Laparoscopic sleeve gastrectomy appears to allow greater weight loss in all BMI classifications over time with fewer reoperations," said Dr. Schumacher. "The most efficient weight loss occurred in the lowest BMI classification.

"Laparoscopic sleeve gastrectomy can be used effectively as a primary operation in any weight classification, achieving a greater than 50% excess weight loss in all BMI subsets."

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New gastric sleeve surgery New procedure helping patients shed pounds

San Antonio, TX

Weight loss surgery, also known as bariatric surgery, is big business these days. You've probably heard of gastric bypass and the LapBand procedure. Now, there is another method helping patient's drop pounds, and one San Antonio doctor is performing it through a single, tiny incision.

A patient at Innova Hospital in Southeast San Antonio is having what's called gastric sleeve surgery, which the doctor describes as an intermediate operation between LapBand and bypass.

"It's not quite as invasive as the gastric bypass in that there's no rearrangement of the anatomy. However, it's a little bit more invasive than the band in that we're excising a portion of the stomach," Dr. John Gonzales Jr. said.

Working through a single incision right at the belly button, the doctor inserts a camera and special tools. Then he cuts off the big, round part of the stomach, actually taking out about two-thirds to three-fourths of the organ. Dr. Gonzales leaves a small tube to hold food. Not only will the patient eat less, she'll feel less hungry.

"The major reason it works is by removing the fundus of the stomach, that sort of big, floppy portion, what you're also removing is a hormone called grehlin. And what we think grehlin is is one of the major hunger hormones," Gonzales said.

The procedure takes less than an hour and a half, and when it's over, there's no outward visible sign the patient has had surgery. The scar is hidden in the belly button. Gonzales is one of a handful of surgeons in the country performing the gastric sleeve surgery this way.

No weight loss is a cure-all. It's simply a tool to help patients cut their portions and eat less. Gastric sleeve is just one more option on the menu for people hungry for a drastic lifestyle change.

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Knoxville woman undergoes sleeve gastrectomy, very pleased with results

Knoxville, TN

Sara Trombley tried every kind of diet on the market. She did Weight Watchers, liquid diets, and pills. Nothing seemed to help her lose weight and keep it off. She began researching surgery options. She was originally a lap-band patient, but then learned about the gastric sleeve procedure. Sara also says she had to overcome her mental issues in regards to eating.

"I struggled with binge eating disorder for a few years and that's when my weight I almost doubled my weight," she says.

The new procedure is called a sleeve gastrectomy and it involves removing part of the stomach. Dr. Mark Colquitt is one of the first physicians in East Tennessee to perform this new procedure. "You cut the stomach and you remove the bottom half and what's leftover is a sleeve," he explains.

Sara had the surgery in February of 2008 and is very pleased with the results. "I've lost 45 pounds and I couldn't have done that with any diet," she says. "I have confidence that it is going to stay off I'm not constantly scared that if I look at a bag of chips the weight is going to come back on."

Dr. Colquitt says the surgery isn't as risky as gastric bypass but some patients can benefit more than others. "Anybody who meets certain criteria as far as weight generally, you are looking at someone who is 100 pounds overweight. We used a scaled called BMI weight and it has to be 35 or greater."

Sara is pleased with her results since the sleeve procedure but says success starts in the mind. "I think the most important thing is to address any mental emotional issues you have with food. You have to get those taken care of or our not going to be successful for me it's the most important thing."

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Sleeve gastrectomy: Gastric bypass surgery alternative

Miami, FL

Gastric bypass surgery has been a life-saving procedure for many morbidly-obese people. During the preparation for that surgery, a patient's stomach may have to be stapled. Now, doctors at UCLA Medical Center say the stomach stapling alone may be very effective to help the patient lose weight.

The procedure is called a "sleeve gastrectomy." It involves trimming down the stomach over a special calibrating tube to 1/3 or ¼ the current size. The surgery is typically reserved for those patients considered to be morbidly obese.

UCLA doctors say the new procedure is still major surgery and the more research is needed, but believe it could become more common than a gastric bypass.

Candidates for most of the new bariatric surgeries must be at least 100 pounds overweight and have medical problems like diabetes, arthritis, or high blood pressure.

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Sleeve gastrectomy: New bariatric procedure turns stomach into small pool

Indianapolis, IN

Question: Describe the sleeve gastroectomy, a new bariatrics surgery option.

Answer: This is just another version of what's already out there. You can break down weight-loss surgical procedures into two categories: One is called restrictive and restricts how much you can take in, such as the lap-band; the other one is called malabsorption and bypasses portions of the intestine or stomach to keep food from getting absorbed as calories.

This is a new restrictive technique. Basically, it's taking off a large portion of the stomach and making the stomach into a small, narrow tube instead of a boot-shaped pouch. We're basically making your stomach into a very small reservoir. More >>

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