BACKGROUBD: Laparoscopic gastric banding (Lap Band) is the most commonly performed morbid obesity operation in Europe. The major benefits of banding are easy reversibility and minimal invasiveness. Laparoscopic Roux-en-Y gastric bypass (RGB) is another effective weight loss procedure. The purpose of this study was to compare the effectiveness (BMI <35 kg/m2) and re-operation rate of Lap Band with laparoscopic RGB.
METHODS: We analyzed patients undergoing Lap Band (n=80) and RGB (n=73) at a single institution.
RESULTS: In the band group, there were 16 men and 64 women. In the RGB group, there were 14 men and 59 women. The table below compares the preoperative and postoperative BMI (kg/m2). Two (2.5%) patients with the Lap Band achieved a BMI<35 kg/m2. Two (2.5%) of laparoscopic banding operations were converted to open. Band slippage occurred in 24 % (n=19) of patients necessitating operative repair in nine cases, removal in six, and replacement in one. Other complications of the band included erosion (n=1, 1.3%), port infection (n=1, 1.3%) and port leak (n=2, 2.5%). Owing to inadequate weight loss, nine patients (11.3%) underwent a second bariatric operation that included laparoscopic RGB (n=6), open vertical banded gastroplasty (n=2), and open RGB (n=1). Overall, twenty-six (33%) of patients with the Lap Band have required re-operation to date. In the laparoscopic RGB group, 56% (n=41) of patients achieved a BMI<35 kg/m2. No operations were converted to open. The wound and intra-abdominal infection rates were 2.7% (n=2) and 1.4% (n=1), respectively. Ten patients (14%) had early anastomotic stricture requiring endoscopic dilation. No RGB patient has required a revision.
CONCLUSIONS: Laparoscopic RGB is more effective than laparoscopic gastric banding in producing weight loss that will reduce obesity-related morbidity. Banding has significant complications that required revision to another bariatric operation. RGB complications were related to the anastomosis but easily addressed by non-operative means.
Body Mass Index (kg/m2)
Preop 6 mos 12 mos 18 mos 24 mos
Band 49 +/-8 44 +/- 8 41 +/-10 40 +/- 8 42 +/- 7
RGB 50 +/-8 33 +/- 10 28 +/12 32 +/-7 29 +/-3