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
Horizontal or vertical banded gastroplasty after pretreatment with very-low-calorie formula diet: a randomized trial.
Horizontal and vertical b and ed gastroplasty ( GP ) were compared as to their effectiveness and side-effects in patients pre-treated for morbid obesity with a very-low-calorie formula diet ( VLCD ) .  The pre-treatment served to select the compliant patients , to minimize the surgical hazard , and to optimize the total weight reduction . Seventy-four consecutive patients ( median age 34 years , median body weight 125.1 kg , and median overweight 93 per cent ) were included according to the criteria for entry . The median weight loss on  VLCD  was 25.7 kg ( range , 5.8 - 92.6 kg ) and the median overweight reduction reached 46 per cent of the initial overweight ( range , 9 - 83 per cent ) . Only few and mild side-effects were observed . Sixty-nine per cent of the patients fulfilled our criterion for surgery by reducing their initial overweight by at least 40 per cent . Of these , 23 and 22 patients were assigned respectively to either vertical b and ed or to horizontal GP . Patients and dietitians were not informed of the assignment . A significant weight loss occurred in both groups . Three months after surgery weight loss after vertical b and ed GP proved to be the larger ( P less than 0.001 ) . The difference became even more pronounced due to an earlier regain among patients treated with the horizontal GP . Thus , at 12 months , the net weight loss after surgery was 9.7 kg ( range , -28.2 - 28.7 kg ) in the vertical b and ed GP group and -1.0 kg ( range , -15.0 - 36.5 kg ) in patients treated with horizontal GP ( P less than 0.0005 ) . At this time , the total weight loss in the groups was 48.5 kg ( range , 6.4 - 104.0 kg ) and 32.6 ( range , 3.7 - 125.1 kg ) respectively ( P less than 0.02 ) , and the total reduction of overweight was greater in the group treated with vertical b and ed GP ( 80 per cent ( range , 10 - 96 ) versus 56 per cent ( range , 8 - 92 ) , P less than 0.005 ) . There were no deaths , and side-effects to VLCD as well as to GP were generally mild . It is concluded that vertical b and ed GP is more effective than horizontal GP and that the former operation adds a significant weight loss to that obtained by VLCD . The combined treatments offer a weight reduction comparable to that observed after jejunoileal bypass . However , some regain within 1 year makes it question able if the vertical b and ed GP is sufficient to prevent weight regain
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