Bariatric surgery appears efficacious compared to st and ard care in reducing BMI .
Weight losses are greatest with diversionary procedures , intermediate with diversionary/restrictive procedures , and lowest with those that are purely restrictive .
Compared with Roux-en-Y gastric bypass , adjustable gastric b and ing has lower weight loss efficacy , but also leads to fewer serious adverse effects
A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.
Vertical b and ed gastroplasty ( VBGP ) was compared with Roux-en-Y gastric bypass ( RYGBP ) in a r and omized prospect i ve trial that included preoperative dietary separation of " sweets eaters " versus " non-sweets eaters . " R and omization was stopped at 9 months after 20 patients had undergone each procedure because a greater weight loss ( p less than 0.05 ) was noted after RYGBP than VBGP . This difference became more significant ( p less than 0.001 ) at each 3-month interval through 3 years , when patients who had VBGPs had lost 37 + /- 20 % of excess weight compared with 64 + /- 19 % for patients who had RYGBPs . The members of the groups were comparable with regard to age , sex , eating habits , morbidity rates before surgery , ideal body weight , and weight before surgery . Although there was no significant difference between the loss of excess weight in " sweets eaters " ( 69 + /- 17 % ) or " non-sweets eaters " ( 67 + /- 17 % ) after RYGBP at 1 year , " sweets eaters " who had VBGPs lost significantly less excess weight ( 36 + /- 13 % ) than did " non-sweets eaters " who had VBGPs ( 57 + /- 18 % ) , p less than 0.02 , or " sweets eaters " who had RYGBPs , p less than 0.0001 . No significant differences were noted for electrolytes , renal or liver function tests , and most vitamins between patients who had VBGPs and RYGBPs ; however , patients who had RYGBPs had lower ( p less than 0.05 ) serum vitamin B12 levels ( 286 + /- 149 pg/dl ) than did patients who had VBGPs ( 461 + /- 226 pg/dl ) at 2 years . By 3 years , the vitamin B12 levels were equal in members of the two groups . Five patients who had RYGBPs required endoscopic stomal dilatation for stomal stenosis and one had a marginal ulcer develop , which responded to cimetidine . RYGBP was clearly superior to VBGP for " sweets eaters , " probably because of the development of dumping syndrome symptoms . However , RYGBP was associated with a larger number of correctable problems . Thus , it is important to evaluate a patient 's eating habits before surgery for morbid obesity ; " non-sweets eaters " probably should be treated with VBGP and " sweets eaters " with RYGBP
Bariatric surgery appears efficacious compared to st and ard care in reducing BMI .
Weight losses are greatest with diversionary procedures , intermediate with diversionary/restrictive procedures , and lowest with those that are purely restrictive .
Compared with Roux-en-Y gastric bypass , adjustable gastric b and ing has lower weight loss efficacy , but also leads to fewer serious adverse effects