Roux-en-Y gastric bypass vs gastric banding for morbid obesity: a case-matched study of 442 patients.

Romy, Sébastien; Donadini, Andrea; Giusti, Vittorio; Suter, Michel

HYPOTHESIS Gastric banding (GB) and Roux-en-Y gastric bypass (RYGBP) are used in the treatment of morbidly obese patients. We hypothesized that RYGBP provides superior results. DESIGN Matched-pair study in patients with a body mass index (BMI) less than 50. SETTING University hospital and regional community hospital with a common bariatric surgeon. PATIENTS Four hundred forty-two patients were matched according to sex, age, and BMI. INTERVENTIONS Laparoscopic GB or RYGBP. MAIN OUTCOME MEASURES Operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity. RESULTS Follow-up was 92.3% at the end of the study period (6 years postoperatively). Early morbidity was higher after RYGBP than after GB (17.2% vs 5.4%; P<.001), but major morbidity was similar. Weight loss was quicker, maximal weight loss was greater, and weight loss remained significantly better after RYGBP until the sixth postoperative year. At 6 years, there were more failures (BMI>35 or reversal of the procedure/conversion) after GB (48.3% vs 12.3%; P<.001). There were more long-term complications (41.6% vs 19%; P.001) and more reoperations (26.7% vs 12.7%; P<.001) after GB. Comorbidities improved more after RYGBP. CONCLUSIONS Roux-en-Y gastric bypass is associated with better weight loss, resulting in a better correction of some comorbidities than GB, at the price of a higher early complication rate. This difference, however, is largely compensated by the much higher long-term complication and reoperation rates seen after GB.