Posted: Jan 16, 2012 7:02 PM
Jan. 16, 2012 -- Gastric banding doesn't work as well as bypass surgery, according to a new study in the journal Archives of Surgery.
More than 200,000 weight loss surgeries are performed annually in the U.S. and more people are choosing banding procedures over gastric bypasses. Banding procedures are marketed as a safer and simpler alternative, but new research suggests that it may not achieve better and lasting results.
Although the complication rate was higher in the bypass group immediately following surgery, banding patients had more long-term complications and more surgical failures.
Several bariatric surgeons who spoke to WebMD called the study long overdue, while another questioned the conclusion that bypass is the best choice for most patients.
"Bypass surgery is not a miracle treatment and many surgeons do not perform it well," says Jacques Himpens, MD, of the European School of Laparoscopy in Brussels, Belgium. "Surgical competency is a big issue with Roux-en-Y gastric bypass." Himpens wrote an editorial of the study.
Over the past two decades, the number of bariatric surgeries performed in the U.S. has increased more than 10-fold.
With a Roux-en-Y gastric bypass surgery, the stomach is reduced in size by 90% to 95% -- from that of a football to a golf ball. The surgery also bypasses a section of the small intestine, which limits calorie absorption.
With a gastric banding procedure, the stomach size is restricted with an adjustable ring, or band.
A third type of weight loss surgery, known as gastric sleeve procedure, reduces the size of the stomach through surgery.
The new study compared outcomes among severely obese patients who had gastric banding and gastric bypass surgeries.
Among the major findings:
Forty-seven of the 221 patients who initially had the banding procedure (21%) ended up having the bands removed.
"At the present time, Roux-en-Y gastric bypass seems clearly superior to gastric banding when treating morbidly obese patients ... researcher Sebastien Romy, MD, and colleagues wrote.
Ronald H. Clements, MD, who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville, Tenn., says the findings come as no surprise.
"Our experience and that of many others is that close to 25% of these bands end up being removed for some reason such as slippage, erosion, or failure to lose weight," Clements says.
Clements adds that aggressive marketing by the gastric banding industry has been largely responsible for the dramatic increase in gastric banding procedures.
"It's common for patients to tell me they want gastric banding because they have seen a commercial for it," he says. "When I explain the pros and cons of banding, bypass, and sleeve procedures, they often change their minds."
American Society for Metabolic and Bariatric Surgery (ASMBS) president Robin Blackstone acknowledges that aggressive marketing of gastric banding is an issue.
"The Society does not favor the direct-to-consumer type of advertising that we are seeing with gastric banding," she says. "We recommend that patients seek out a center which offers a variety of procedures and also offers counseling to address the risks and benefits of each one."
Himpens says gastric banding can be a better option than bypass if patients do not have access to surgeons who specialize in bypass surgery or if they will not be followed closely after surgery.
Clements, Blackstone, and Himpens agree that gastric bypass or sleeve surgeries are generally preferable to banding for one group of patients -- people with type 2 diabetes.
Allergan, Inc., markets the Lap-Band gastric banding system, which is the most widely used gastric band in the U.S.
In a written statement, an Allergan spokesperson highlighted what the company called "specific weaknesses" in the study, including:
"Although we applaud the high six-year follow-up rate of these bariatric patients, it would be inappropriate to draw conclusions regarding the relative risks and benefits of either procedure based on this single study," according to Allergan.