title: Comparative effectiveness of laparoscopic adjustable gastric banding vs laparoscopic gastric bypass.
abstract: OBJECTIVE
  Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures.
  
  
  OBJECTIVE
  To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes.
  
  
  METHODS
  A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States.
  
  
  METHODS
  The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention.
  
  
  RESULTS
  We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score-adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively.
  
  
  CONCLUSIONS
  In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: David
authors.initials: D
authors.lastname: Arterburn
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors.forename: J David
authors.initials: JD
authors.lastname: Powers
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Sengwee
authors.initials: S
authors.lastname: Toh
authors.affiliation: University of Colorado School of Medicine, Aurora.
authors.forename: Sarit
authors.initials: S
authors.lastname: Polsky
authors.affiliation: Kaiser Permanente Georgia Center for Health Research Southeast, Atlanta.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors.forename: J Dickman
authors.initials: JD
authors.lastname: Portz
authors.affiliation: University of Colorado School of Medicine, Aurora6Colorado Permanente Medical Group, Aurora.
authors.forename: William T
authors.initials: WT
authors.lastname: Donahoo
authors.affiliation: Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Herrinton
authors.affiliation: University of Hawai'i at Manoa, Honolulu.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Williams
authors.affiliation: Kaiser Permanente Hawaii Center for Health Research, Honolulu.
authors.forename: V
authors.initials: V
authors.lastname: Vijayadeva
authors.affiliation: Kaiser Permanente, Oakland, California.
authors.forename: David
authors.initials: D
authors.lastname: Fisher
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult