Magazine article Clinical Psychiatry News
Weight Loss Greater with Gastric Bypass Than Gastric Banding
BOSTON -- Compared with gastric bypass surgery, both laparoscopic gastric bypass and laparoscopic gastric banding are safer surgical procedures, Dr. R. Armour Forse said at a symposium on treating gastrointestinal disorders sponsored by Boston University.
As an open operation, gastric bypass produces more weight loss and greater resolution of comorbidities than do other procedures. But safety concerns have focused attention on the laparoscopic alternatives, said Dr. Forse, the Laszlo N. Tauber professor of surgery at the university.
A prospective, randomized trial is needed to compare the two laparoscopic procedures, but organizing such a study will be increasingly difficult to do.
In addition to the problem of securing funding, enrolling patients could be a challenge.
Nonetheless, the available data are "rather compelling," he said in his review of published studies which clearly favor laparoscopic gastric bypass.
The first major study that Dr. Forse cited was a Food and Drug Administration safety and efficacy trial evaluating laparoscopic gastric banding from 1995 to 1998. After 36 months, patients had lost only about 50 pounds and had a body mass index (BMI) of 38.7 kg/[m.sup.2]. "They're still obese," he said.
Among the 299 patients who were monitored for adverse events, 51% had nausea and vomiting, 34% had reflux, 27% had abdominal pain, and 24% of the patients had slippage or dilation of the pouch.
Yet the procedure has gained acceptance in the United States based on evidence that some patients have done well. …