SUMMARY: Gastric bypass surgery has better long-term result than gastric band surgery, but comes with more potentially serious complications just after the surgery, according to new research.
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NEW YORK (Reuters Health) - Among weight-loss surgery options, gastric bypass comes with more complications shortly after surgery than gastric banding, but makes up for it with fewer long-term side effects and repeat operations, new research suggests.
People who got bypass surgery also lost weight faster, and more kept it off, in the study of more than 400 obese Swiss patients.
"What we would like with any of the (weight-loss) procedures ideally would be to have the least long-term complications, certainly the least long-term complications requiring (repeat) surgery," said Dr. Michel Suter, a surgeon from the Hopital du Chablais, Aigle, who worked on the study.
"There are drawbacks with bypass, there are side effects, and we have to take them into account," he told Reuters Health. But "overall, if I had to choose between the procedures, I certainly recommend the bypass."
Still, one researcher not involved in the study said that when complications do happen with gastric bypass, they are often more serious than complications after banding.
Suter and his colleagues looked back at records of 442 obese patients who underwent weight-loss surgery at their hospitals between 1998 and 2005.
To qualify for surgery, all patients had to have a body mass index -- a measure of weight in relation to height -- of at least 40, or at least 35 if they also had an obesity-related illness. That's the equivalent of a five-foot, six-inch person weighing at least 248 pounds or 217 pounds, respectively.
Half of the patients had gastric band procedures, which involve placing a band around the top of the stomach to limit its size to a small pouch. The other half were treated with gastric bypass, when part of the stomach is stapled off and then rerouted to bypass a segment of the small intestine. The two groups were similar in terms of their age and initial weight.
Doctors checked in with those patients at least twice a year for the next six years post-surgery.
Complications in the month after the procedure -- which typically include infections -- were more common after gastric bypass than after banding: 17 percent of bypass patients had any surgery-related problems, compared to five percent in the banding group.
"The operation itself is a little more complicated and a little more risky," Suter explained.
But after that point, the bypass group lost weight faster, put less of it back on and suffered fewer long-term complications, including those that called for a repeat procedure.
Six years post-surgery, 12 percent of bypass patients had a body mass index above 35, considered severely obese, compared to one-third after gastric banding.
And thirteen percent of patients needed re-operation after complications with gastric bypass, versus close to 27 percent following banding.
The long-term complications of gastric banding were generally related to the band eroding and needing to be removed, food intolerance or stretching of the esophagus, the researchers reported Monday in the Archives of Surgery.
With gastric bypass, patients most often had internal hernias, a type of bowel blockage that can be life-threatening if not treated.
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