Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity A Case-Matched Study of 442 Patients

Hypothesis: Gastric banding (GB) and Roux-en-Y gastric bypass (RYGBP) are used in the treatment of morbidly obese patients. We hypothesized that RYGBP provides superior results. Design: Matched-pair study in patients with a body mass index (BMI) less than 50. Setting: University hospital and regional community hospital with a common bariatric surgeon. Patients: Four hundred forty-two patients were matched according to sex, age, and BMI. Interventions: Laparoscopic GB or RYGBP. Main Outcome Measures: Operative morbidity, weight loss, residual BMI, quality of life, food tolerance, lipid profile, and long-term morbidity. Results: Follow-up was 92.3% at the end of the study period (6 years postoperatively). Early morbidity was higher after RYGBP than after GB (17.2% vs 5.4%; P <.001), but major morbidity was similar. Weight loss was quicker, maximal weight loss was greater, and weight loss remained significantly better after RYGBP until the sixth postoperative year. At 6 years, there were more failures (BMI > 35 or reversal of the procedure/conversion) after GB (48.3% vs 12.3%; P <.001). There were more long-term complications (41.6% vs 19%; P <.001) and more reoperations (26.7% vs 12.7%; P <.001) after GB. Comorbidities improved more after RYGBP. Conclusions: Roux-en-Y gastric bypass is associated with better weight loss, resulting in a better correction of some comorbidities than GB, at the price of a higher early complication rate. This difference, however, is largely compensated by the much higher long-term complication and reoperation rates seen after GB.