title: Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study.
abstract: BACKGROUND
  Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study was to compare the effectiveness and safety of the three most performed bariatric procedures.
  
  
  METHODS
  A multicenter, retrospective, matched cohort study was conducted. Patients were eligible for analysis when a primary procedure was performed between 2007 and 2010 in one of the two specialized bariatric centers. Primary outcome was weight loss, expressed in the percentage excess weight loss (%EWL). Secondary outcome parameters are hospital stay, complication rate, and revisional surgery.
  
  
  RESULTS
  In total, 735 patients, 245 in each group, were included for analysis. The groups were comparable for age and gender after matching. Mean postoperative follow-up was 3.1 ± 1.2 years. LAGB patients showed less %EWL compared to LSG and LRYGB at all postoperative follow-up visits. LRYGB showed a %EWL of 71 ± 20 % compared to LSG (76 ± 23 %; p=0.008) after 1-year follow-up; thereafter, no significant difference was observed. After 3 years of follow-up, LAGB showed a higher complication rate compared to LSG and LRYGB (p<0.05). Revisional surgery after LAGB was needed in 21 %, while 9 % of the LSG underwent conversion to RYGB.
  
  
  CONCLUSIONS
  LRYGB is a safe and effective treatment in morbid obese patients with good long-term outcomes. LSG seems to be an appropriate alternative as a definitive procedure, in terms of weight reduction and complication rate. LAGB is inferior to both LRYGB and LSG.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Postal number 1190, PO box 9555, 6800 TA, Arnhem, The Netherlands, dogan_kemal@hotmail.com.
authors.forename: Kemal
authors.initials: K
authors.lastname: Dogan
authors.forename: Ralph P M
authors.initials: RP
authors.lastname: Gadiot
authors.forename: Edo O
authors.initials: EO
authors.lastname: Aarts
authors.forename: Bark
authors.initials: B
authors.lastname: Betzel
authors.forename: Cees J H M
authors.initials: CJ
authors.lastname: van Laarhoven
authors.forename: Laser U
authors.initials: LU
authors.lastname: Biter
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Aufenacker
authors.forename: Ignace M C
authors.initials: IM
authors.lastname: Janssen
authors.forename: Frits J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss