title: Long-term results of a randomized clinical trial comparing Roux-en-Y gastric bypass with vertical banded gastroplasty.
abstract: BACKGROUND
  The long-term results of Roux-en-$\hbox{Y}$ gastric bypass (gastric bypass) and vertical banded gastroplasty (VBG) from randomized studies have not been described in detail.
  
  
  METHODS
  Patients were randomized to gastric bypass or VBG. Body mass index (BMI), body composition, eating habits and gastrointestinal hormones were reviewed after 6 years. The frequency of reoperation was assessed up to 10 years after surgery.
  
  
  RESULTS
  Sixty-six (80 per cent) of the 82 subjects randomized were assessed for weight and BMI 6 years after surgery, 30 (81 per cent) in the gastric bypass group and 36 (80 per cent) in the VBG group. Intention-to-treat analysis demonstrated greater weight loss after gastric bypass compared with VBG, 6 years after surgery: BMI reduced from 41·8 (95 per cent confidence interval 41·3 to 42·3) to 30·3 (28·6 to 32·0) kg/m(2) for gastric bypass and from 42·3 (42·8 to 44·8) to 32·9 (31·3 to 34·5) kg/m(2) for VBG (P = 0·036). Gastric bypass caused a larger loss of fat mass (P = 0·026) and better preservation of lean tissue (P = 0·009). Patients having a gastric bypass had greater postprandial responses to the satiety hormones glucagon-like peptide 1 and peptide YY (P = 0·003 and P = 0·004 respectively). Ghrelin levels did not differ between the groups. Patients with a gastric bypass maintained a lower intake of fat compared with those having VBG (P = 0·013). Some 89 per cent of patients who initially had VBG had undergone, or were scheduled for, conversion to gastric bypass at latest follow-up.
  
  
  CONCLUSIONS
  Gastric bypass was superior to VBG regarding weight loss, body composition, dietary composition and postprandial satiety hormone responses.
authors.affiliation: Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Gothenburg, Sweden. malin.werling@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Werling
authors.forename: L
authors.initials: L
authors.lastname: Fändriks
authors.forename: P
authors.initials: P
authors.lastname: Björklund
authors.forename: A
authors.initials: A
authors.lastname: Maleckas
authors.forename: J
authors.initials: J
authors.lastname: Brandberg
authors.forename: H
authors.initials: H
authors.lastname: Lönroth
authors.forename: C W
authors.initials: CW
authors.lastname: le Roux
authors.forename: T
authors.initials: T
authors.lastname: Olbers
mesh_terms: D015992:Body Mass Index; D004435:Eating / Q000502:physiology; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D054439:Ghrelin / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery; D019894:Peptide YY / Q000097:blood; D012086:Reoperation; D015431:Weight Loss
chemical_list: D054439:Ghrelin; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1