title: Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity.
abstract: OBJECTIVE
  To define whether laparoscopic gastric banding or laparoscopic Roux-en-Y gastric bypass represents the better approach to treat patients with morbid obesity.
  
  
  BACKGROUND
  Two techniques, laparoscopic gastric bypass or gastric banding, are currently widely used to treat morbid obesity. Since both procedures offer certain advantages, a strong controversy exists as to which operation should be proposed to these patients. Therefore, data are urgently needed to identify the best therapy.
  
  
  METHODS
  Since randomized trials are most likely not feasible because of the highly different invasiveness and irreversibility of these procedures, a matched-pair design of a large prospectively collected database appears to be the best method. Therefore, we used our prospective database including 678 bariatric procedures performed at our institution since 1995. A total of 103 consecutive patients with laparoscopic gastric bypass were randomly matched to 103 patients with laparoscopic gastric banding according to age, body mass index, and gender.
  
  
  RESULTS
  Both groups were comparable regarding age, gender, body mass index, excessive weight, fat mass, and comorbidites such as diabetes, heart disease, and hypertension. Feasibility and safety: All gastric banding procedures were performed laparoscopically, and one gastric bypass operation had to be converted to an open procedure. Mean operating time was 145 minutes for gastric banding and 190 minutes for gastric bypass (P < 0.001). Hospital stay was 3.3 days for gastric banding and 8.4 days for gastric bypass. The incidence of early postoperative complications was not significantly different, but late complications were significantly more frequent in the gastric banding group (pouch dilatation). There was no mortality in both groups. Efficiency: Body mass index decreased from 48.0 to 36.8 kg/m in the gastric banding group and from 47.8 to 31.9 kg/m in the gastric bypass group within 2 years of surgery. These differences became significant from the first postoperative month until the end of the follow-up (24 months). The gastric bypass procedure achieved a significantly better reduction of comorbidities.
  
  
  CONCLUSIONS
  Laparoscopic gastric banding and laparoscopic gastric bypass are feasible and safe. Pouch dilatations after gastric banding are responsible for more late complications compared with the gastric bypass. Laparoscopic gastric bypass offers a significant advantage regarding weight loss and reduction of comorbidities after surgery. Therefore, in our hands, laparoscopic Roux-en-Y gastric bypass appears to be the therapy of choice.
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. markus.weber@usz.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
authors.forename: Markus K
authors.initials: MK
authors.lastname: Müller
authors.forename: Tanja
authors.initials: T
authors.lastname: Bucher
authors.forename: Stefan
authors.initials: S
authors.lastname: Wildi
authors.forename: Daniel
authors.initials: D
authors.lastname: Dindo
authors.forename: Fritz
authors.initials: F
authors.lastname: Horber
authors.forename: Rennward
authors.initials: R
authors.lastname: Hauser
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015431:Weight Loss