American Surgical Association
2009 Annual Meeting Abstracts

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A Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity
Ninh T Nguyen, *Johnathan A Slone, *Marcelo W Hinojosa, David B Hoyt
UC Irvine Medical Center, Orange, CA

Background: There have been few randomized trials comparing the efficacy of weight loss and outcomes between laparoscopic gastric bypass and banding.
Methods: Between 2003-2007, 250 patients with a body mass index of 40-60 kg/m2 were randomly assigned to bypass or band groups. Outcome measures are listed in the following table.
Results:
Operative Data, Complications, and Weight LossGastric Bypass
(n=112)
Gastric Banding
(n=86)
p Value
Preoperative BMI (kg/m2)47.4 ± 5.645.5 ± 5.3<0.05*
Age (years)41 ± 1146 ± 10<0.01*
Operative time (min)136 ± 3368 ± 25<0.01*
Estimated blood loss (ml)80 ± 4921 ± 24<0.01*
No. patients requiring ICU stay (%)2.7 %1.2 %NS†
Mean length of hospital stay (days)3.1 ± 1.41.5 ± 1.0<0.01†
No. patients requiring transfusion (%)2.7 %0 %N/A
Major complications7.1 %1.2 %NS†
Minor complications13.4 %3.5 %<0.05†
Late complications32.1 %11.6 %<0.01†
Return to normal activity (days)14.4 ± 12.610.7 ± 10.3<0.05†
Return to work (days)20.8 ± 13.614.2 ± 10.1<0.01†
% Excess body weight loss at 2 years71.6 ± 19.4 %52.1 ± 29.4 %<0.01†

Data are given as mean ± SD. NS=nonsignificant (p>0.05); * 2-sample t-tests; † Fisher’s exact tests.
In both groups, none of the patients required conversion to laparotomy. There were no leaks in the gastric bypass group. The most frequent late complication in the gastric bypass group was stricture (14.3%). One (0.9%) of 112 patients in the gastric bypass group had reversal of the procedure for late hemorrhage from marginal ulcer and 5 (5.8%) of 86 patients in the gastric band group had removal of their band for late complications or failure of weight loss. The 90-day mortality was 0% for both groups. The 1-year mortality was 0.9% for gastric bypass and 0% for gastric band group.
Conclusions: Laparoscopic gastric bypass and gastric banding are safe and effective approaches to treatment of morbid obesity. Laparoscopic gastric bypass is associated with longer operative times and hospital stays and higher minor and late complications. In contrast, laparoscopic gastric bypass is associated with better weight loss at medium-term follow-up.


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