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A Case-Matched Study of 442 Patients

Sébastien Romy, MD; Andrea Donadini, MD; Vittorio Giusti, MD, PD; Michel Suter, MD, Prof

Arch Surg. Published online January 16, 2012. doi:10.1001/archsurg.2011.1708

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.

Author Affiliations: Department of Visceral Surgery (Drs Romy, Donadini, and Suter) and Division of Endocrinology, Diabetology, and Metabolism (Dr Giusti), Centre Hospitalier Universitaire Vaudois, Lausanne, and Department of Surgery, Hôpital du Chablais, Aigle-Monthey (Dr Suter), Switzerland.

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