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Band and Bypass, 6 year data
January 31, 2012
Dr. Christine Ren Fielding was interviewed in an article about a six year match-paired study, comparing the Roux-en-Y gastric bypass procedure with gastric banding. According to the study, Roux-en-Y gastric bypass and gastric banding both have excellent weight loss outcomes at six years. The findings of the match-paired study in Switzerland showed that gastric bypass patients shed on average 78.5% of their excess weight after six years, while gastric banding patients shed on average 64.8%. The study compared a total of 442 bariatric surgery patients, 221 of which received gastric banding and the other 221 a gastric bypass procedure. The patients were followed from 1998-2005. On average, according to the analysis, maximal weight loss was achieved 36 months after following gastric banding procedure and 18 months following Roux-en-Y gastric bypass. Both groups showed significant improvements in Body Mass Index (BMI) at six years post-op: only 2.4 percent of the Roux-en-Y group had a BMI greater than 40, and just 13.8 percent of the gastric banding group. Additionally, improved quality of life was reported in both groups. The bypass group had greater improvements in both fasting glucose levels and lipid profiles; however, the researchers found that there were significantly more early complications after Roux-en-Y (17.2%) than after gastric banding (5.4%). Roux-en-Y is a more complex procedure surgically than gastric banding, and requires both a longer operative time and longer hospital stay.
One concerning aspect of the study was that it did not report the specific details of the complications and their respective severity. Dr. Christine Ren Fielding explained in the article: “I am troubled by the fact that the authors do not give the details of the specific types of complications and how serious they are. We know that not all complications are alike. For example, a wound infection treated with antibiotics is not the same as an anastomotic leak which requires re-operation and extended hospitalization.” Dr. Ren Fielding also commented on the high rate of band erosion (7 percent) that was cited in the article, saying that “surgical technique and surgical ability can affect complication rates of any surgery.” She explained how bariatric practices in Mexico were seeing band erosion rates as high as ten percent, but how their rates decreased through modifying their surgical techniques.
Dr. Ren Fielding concluded that her philosophy is one of "helping the patient be successful and optimizing outcomes, regardless of which operation they have, because all bariatric surgeries have their overwhelming benefits in treating the disease of obesity. "
The research was published January 2012 online in the Archives of Surgery.