Jay C. Jan, Dennis Hong, Emma Patterson, Legacy Health System, Portland, OR

Background: Worldwide, laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity. Few studies have compared gastric bypass and gastric banding. Methods: All patients who underwent LRYGB and LAGB by a single surgeon at Legacy Health System were identified from a prospectively-maintained database. Preoperatively, patients were allowed to choose between LRYGB and LAGB. Age, sex, body mass index (BMI), major and minor complication rates, mortality and weight loss were examined. Results: From October 2000 to November 2003, 219 patients underwent LRYGB and 153 patients underwent LAGB. Mean BMI was 49.4 and 50.6 kg/m2 (p = 0.17) respectively. Mean age was 42.2 and 46.7 years (p < 0.0001). Patients undergoing LRYGB had longer operative times (134.5 vs. 76.7 minutes, p < 0.0001), blood loss (42.3 vs. 28.2 mL, p < 0.01) and hospital stay (2.6 vs. 1.3 days, p < 0.0001). Excess weight loss was 34.4% for LRYGB vs. 18.5% for LAGB at 3 months follow-up (p < 0.0001), 48.8 vs. 25.9% at 6 months (p < 0.0001), 61.6 vs. 42.1% at 12 months (p < 0.0001), 73.3 vs. 53.3% at 24 months (p < 0.01), and 70.1 vs. 66.1% at 36 months (p = 0.9). Major complications occurred in 5.9% and 3.3% (p = 0.33) and minor complications occurred in 19.2% and 16.3% (p = 0.5), respectively. One death occurred in each group. Conclusions: Patients undergoing laparoscopic adjustable gastric banding have shorter operative times and decreased blood loss and length of hospital stay compared to laparoscopic gastric bypass patients. Early weight loss is greater with gastric bypass, but the difference appears to diminish over time. Longer follow-up is needed.