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RYGB vs LAGB

RYGB betters LAGB in super-obese patients

Study supports use of LRYGB in super-obese patients
Banding suitable in high-risk patients if willing to partake in postoperative educational programmes

Laparoscopic Roux-en-Y gastric bypass (LRYGB) results in greater excess weight loss compared with laparoscopic adjustable gastric banding (LAGB) in super-obese (BMI>50) patients, according to a Finnish study published in the Scandinavian Journal of Surgery, with early outcomes (six and 12 months) showing no significant difference in the overall postoperative morbidity.

The investigators from Turku University Hospital, Turku, and Vaasa Central Hospital, Vaasa, Finland, write that although LRYGB is known to be beneficial with regards to weight loss, gastric banding maybe advantageous in high-risk patients due to the less-invasive nature of the procedure and its reduced short-term complication rate. There are few studies comparing the procedures in the super-obese population.

They subsequently designed a study to compare the early outcomes and peri-operative complications of both procedures in super-obese patients including % excess weight loss, major and minor complications, operative time, intra-operative complications and hospital stay.

This retrospective study review collected data on 733 patients who received RYGB (n=436) or LAGB (n=297) between 2006 and 2009. Of these patients, 181 (24.69%) were classified as super-obese; 102 in Group 1 (LRYGB) and 79 in Group 2 (LAGB).

Outcomes

There were no significant differences in the demographics between the two groups two groups. The results revealed there were also no significant differences in operative time (93.51 ± 33.32 vs 87.72 ± 39.24 min), conversion rates (0% in both groups), or hospital stay (2.68 ± 2.27 vs 2.75 ± 1.84). In the bypass group, six patients (5.9%) had intra-operative complications due to anastomotic or gastric pouch leak during intra-operative leak testing and there were no intra-operative complications (0.0%), in the banding group (a significant difference, p = 0.04).

There were no significant differences in overall early postoperative complication rates between the groups, although the LRYGB group had a higher early morbidity rate (17.65% vs 10.12%, p=0.20) compared to the LAGB group. Overall number of complications was not significantly higher in Group 1 (21 vs 12, p = 0.44).

The mean weight loss (WL), after LRYGB was significantly greater at both six- and 12-month follow-up, compared with LAGB. In addition, BMI at six and 12 months was significantly lower after LRYGB. The EWL% mean values were also significantly higher at 6 and 12 months in the LRYGB group (Table 1).

Table 1: Comparison of weight loss outcomes in Group 1 and Group 2 patients.

The authors state that the only significant difference in overall early morbidity between the groups was the slightly higher incidence of intra-operative and anastomosis-related complications in the LRYGB group. However, 11 of the super-obese patients undergoing LRYGB were operated during the team’s learning curve period for the bypass procedure, and therefore could have influence the interpretation of the overall early morbidity outcomes.

“In conclusion, super-obese patients have higher postoperative complications and higher failure rate after bariatric surgery compared to morbid obese patients; therefore, different assessing criteria might be used for the management of this challenging population. Our study supports the primary use of LRYGB as a safe procedure in super-obese patients,” the writers note. “LAGB can be one of the accepted surgical tools for WL for high-risk patients willing to be involved in a regular and long-term postoperative WL management educational programme. The results of this study should be interpreted with caution as it is a not randomized study, and there is likely to be some form of selection bias which might have a confounding effect.”

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