title: Safety and effectiveness of bariatric surgery: Roux-en-y gastric bypass is superior to gastric banding in the management of morbidly obese patients: a reply to the response by Bhoyrul et al.
abstract: BACKGROUND
  We have read the letter by Bhoyrul et al. in response to our recently published article "Safety and effectiveness of bariatric surgery: Roux-en-Y gastric bypass is superior to gastric banding in the management of morbidly obese patients". We strongly disagree with the content of the letter.
  
  
  CONCLUSIONS
  Bhoyrul et al. base their letter mostly on low level evidence such as single-institutional case series (level IV evidence) and expert opinion (level V evidence). Surprisingly, they do not comment on the randomized controlled trial, which clearly favours gastric bypass over gastric banding.
  
  
  CONCLUSIONS
  The letter by Bhoyrul et al. is based on low level evidence and is itself biased, unsubstantiated, and not supported by the current literature.
authors.affiliation: Center for Excellence in Bariatric Surgery, Humber River Regional Hospital Finch Site, University of Toronto, Department of Surgery, Toronto, ON, M3N 1N1, Canada. johnhagen@bellnet.ca.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Lazar V
authors.initials: LV
authors.lastname: Klein
authors.forename: John A
authors.initials: JA
authors.lastname: Hagen
references.citation: Surg Obes Relat Dis. 2007 Mar-Apr;3(2):127-32; discussion 132-3
references.pmid: 17331805
references.citation: Am J Med. 2008 Oct;121(10):885-93
references.pmid: 18823860
references.citation: Patient Saf Surg. 2009 May 29;3(1):10
references.pmid: 19476654
references.citation: Patient Saf Surg. 2009 Jul 28;3(1):17
references.pmid: 19638236