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
Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison
Background : Vertical b and ed gastroplasty ( VBG ) and gastric bypass ( GBP ) are the two bariatric procedures recommended by NIH consensus conference . Recent advancement in laparoscopic ( L ) techniques has made LVBG and LGBP alternatives for the conventional open approach . Methods : From December 2000 to February 2002 , 80 patients ( 24 men and 56 women ; mean age 32 years , range 18 - 57 ) with morbid obesity ( mean BMI 43.2 kg/m2 , range 36 - 59.8 ) were enrolled in a prospect i ve trial and r and omly assigned to LVBG or LGBP .  Changes in quality of life were assessed using the Gastro-intestinal quality of life index ( GIQLI ) . Results : The conversion rate was zero for LVBG and 2.5 % ( 1/40 ) for LGBP . There has been no mortality . Surgical time was significantly longer for LGBP ( 209 minvs 126 min for LVBG , P<0.001).Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP ( P<0.001 ) . Postoperative analgesic usage was also less for LVBG patients ( mean dose 1.4 vs 2.4 , P<0.05 ) . Early complication rate was higher in the LGBP group ( 17.8 % vs 2.5 % , P<0.001 ) . All 3 major complications were in the LGBP group , of which 2 were related to anastomotic leakage ( 5 % ) . Late complications consisted of upper GI bleeding , stenosis and others observed in 4 LGBP patients ( 10 % ) and 2 LVBG patients ( 5 % ) . Mean follow-up was 20 months ( range 18 to 30 ) . BMI fell significantly in both groups , with significant improvement of obesity-related co-morbidities . LGBP had significantly better excess weight loss than LVBG ( 62.9 % vs 55.4 % at 1 year and 71.4 % vs 53.1 % at 2 years ) , as well as lower BMI than LVBG ( 29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years ) . There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP ( 11.8 vs 13.8 , P<0.05 ) . Preoperative GIQLI scores were similar between the groups ; however , at 1 year , LGBP patients had better GIOLI scores than LVBG patients ( 121 vs 106 , P<0.01 ) . LVBG had improvement in physical condition , social function and emotional conditioning but deterioration in GI symptoms which result ed in no increase in total GIQLI score . Conclusion : LGBP was a time-consuming dem and ing technique with a higher early complication rate compared with LVBG . Although both operations result ed in significant weight reduction and decrease in obesity-related co-morbidities , LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state . Each patient should be individualized for the operations according to the patient 's decision
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