A research project recently completed by The University of Adelaide extracted data from the prospective databases of two Adelaide bariatric surgeons and independently examined the results. The methodology focused on weight loss outcomes of 2 procedures; RYGB (1995-2009; n=609; 493F:116M; 42.4±0.4yrs) and LAGB (2004-2009; n=686; 555F:131M; 37.2±0.4yrs).
2 abstracts from the study have been presented at the 2011 Australian Obesity Medicine meeting (ANZOS), the 2011 State Population Health Conference, and the SA Gut Club on 1st September 2011.
The following comments reflect Dr. Bessell’s interpretation of the results, distilled for general information.
FINDINGS AND INTERPRETATION:
1. Both LapBand (LAGB) and Gastric Bypass (RYGB) procedures were effective bariatric procedures, inducing substantially more weight loss that has been reported from standard or non-surgical weight loss programs. The longevity of the weight loss from both procedures has been substantiated by the results of this study.
2. At all time points, RYGB induced a significantly greater degree of weight loss than that of LAGB, and for both procedures, peak weight loss occurred in the 4-5th year after surgery. The superiority of RYGB and the magnitude of BMI reductions in both groups were commensurate with that reported elsewhere in the literature. However many bariatric patients have an initial tendency to judge the success of their operation on the basis of early weight loss outcomes, and it will be helpful to counsel patients more effectively now we can indicate the longer time frames required to achieve best results.
3. For all categories of BMI, RYGB induced significantly greater degree of weight loss than that of LAGB and the differences are greatest for those with the higher BMI. All bariatric patients should be counselled to consider RYGB as a primary bariatric procedure. In particular patients who have a large amount of weight to lose should be actively considering RYGB as the primary bariatric procedure, although there is a direct relationship between the initial BMI and the degree of weight loss induced by both types of surgery.
4. Males who underwent LAGB have a greater weight loss than females after 3 years; and had significantly less long-term complications related to gastric bands. In fact the LAGB delivered males up to a 10 BMI point reduction after 3 years, indicating the procedure is surprisingly effective in this subgroup of patients. Obese males can confidently consider LAGB as an effective option for their bariatric needs.
5. Early postoperative complications occurred in 1% of LAGB patients. As has been previously reported, this procedure is an extremely safe option for bariatric patients. In contrast, RYGB has a substantially higher short-term complication rate (11%) with some complications being of significant severity (wound dehiscence, incisional hernia, bowel obstruction, abdominal sepsis, splenic trauma, DVT/PE) none of which were evident in the LAGB group.
6. This study showed a 2.3% port replacement rate, lower than has been previously reported in the literature.
7. The results of this study are surprisingly similar to recently published systematic reviews and meta-analysis of randomised trials, which I have also appended below.
For band-related secondary reinterventions, what is interesting is that;
- the reintervention rate is only 5.7%, again lower than reported in other studies. The Europeans for example, cite reports of up to 30 – 40% band removal rates, which is clearly not reflected in current
- secondary reintervention by both RYGB and replacement of LAGB resulted in substantial ongoing weight loss
- with RYGB being the superior salvage procedure. I think it is important to highlight the important role of RYGB as a salvage procedure in bariatric surgery.
- Bariatric patients should be offered LAGB or RYGB for consideration as effective primary bariatric procedures.
- LAGB has less weight loss than RYGB, but has a shorter length of stay, a quicker recovery, and is extremely safe, even for this high-risk group of surgical patients. Males do well with this procedure.
- RYGB has more efficacious long-term weight loss, but at the cost a higher short term complication rate, some of which can be serious. RYGB has a simplified postoperative course, and band-fills are not required, and is particularly suitable for patients in regional and remote areas in whom long distances many be required to access band adjustments. RYGB is particularly suitable for patients with a very high starting BMI, as its efficacy is particularly evident in this subgroup.
- 93% of LAGB patients will not require surgical reintervention, and for the 5% who need band-related surgery, the secondary reintervention is highly effective and restores weight loss to that enjoyed by the primary bariatric surgery subgroup. RYGB is particularly useful as a salvage procedure, and may be increasingly required in the future, and forms an important part of the skillset required in any bariatric clinic. Reintervention for primary RYGB is very rarely required.