Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada.

Abstract

BACKGROUND: Bariatric surgery remains the most effective modality to induce sustainable weight loss in the morbidly obese. Our aim was to compare outcomes between the laparoscopic Roux-en-Y gastric bypass (LRYGBP) and the laparoscopic adjustable gastric banding device (LAGBD) method with 5-year follow-up in a Canadian bariatric surgery centre. METHODS: This is a retrospective outcomes analysis of 1035 laparoscopic bariatric procedures performed over 7 years. We extracted data from our prospectively collected bariatric surgery registry from Feb. 1, 2002, to Jun. 30, 2008. We evaluated patient demographics, weight loss, complications, mortality and need for revision surgery by procedure type. RESULTS: We examined outcomes in 149 (14.4%) LAGBD and 886 (85.6%) LRYGBP procedures. The mean body mass index (BMI) was significantly higher in the LRYGBP group (50.9, standard deviation [SD] 8.9, v. 45.0, SD 6.7) whereas age and sex ratio were the same. There were 3 deaths (0.3%) in the LRYGBP group and no deaths in the LAGBD group. Sixteen patients (10.8%) in the LAGBD group needed conversion to LRYGBP because of poor weight loss, band intolerance, band erosion or slippage, and 6 patients (0.7%) in the LRYGBP group required revision because of inability to achieve the desired weight loss. The percent excess-weight loss was 41, 49, 59, 60 and 61 at 1, 2, 3, 4 and 5 years postsurgery for the LAGBD patients who kept their band, and 70, 79, 79, 79 and 75 for the LRYGBP patients. CONCLUSION: Laparoscopic weight loss surgery can be performed safely with acceptable mortality. Our study suggests superior weight loss and low revision requirement for the LRYGBP, making this a more durable procedure in a publicly funded health care system.