19 November 2018

Which weight-loss surgery is best?

New research compared three types of surgery: gastric bypass, sleeve gastrectomy and adjustable gastric banding.

Deciding to have weight-loss surgery is tough enough, but then you have to choose between several procedures – each with different risks and potential weight loss.

So how do you decide which one is best for you?

Greatest weight loss

New research that compares three types of weight-loss surgery in more than 46 000 patients may help. The three types of surgery included gastric bypass, sleeve gastrectomy and adjustable gastric banding (also known as lap band).

The study found that gastric bypass surgery boasted the greatest weight loss – both short- and long-term. But that procedure also had the highest rates of complications in the month following surgery.

"There are trade-offs. Bypass is more effective for weight loss, but has a greater risk of short-term complications. People need to consider, 'What do I value most?' Is safety your biggest concern? Or, is it the magnitude of the weight loss?" said study lead author Dr David Arterburn. He's a senior researcher at the Kaiser Permanente Washington Health Research Institute in Seattle.

Arterburn added that it's important to consider other weight-loss treatments, such as medication.

Three different procedures

Nearly 25 000 people in the study had Roux-en-Y gastric bypass. This procedure involves making the stomach smaller and bypassing part of the small intestine, according to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). After this surgery, people get fuller on much less food, and the body doesn't absorb as many calories.

Almost 19 000 people in the study had sleeve gastrectomy, which involves taking out a portion of your stomach so that you get fuller faster.

Finally, more than 2 500 people had adjustable lap-band surgery. A surgeon places an inflatable band around the top of your stomach, leaving only a small pouch that can be filled with food. The rest of your stomach is filled with a balloon containing saline solution that is attached to the band, according to NIDDK. Arterburn said this procedure has fallen out of favour in recent years.

The study found that gastric bypass appeared to be most effective for weight loss:

  • Gastric bypass surgery resulted in an average 31% loss of total body weight in the first year and 25% of total body weight after five years.
  • Sleeve gastrectomy led to a 25% loss in total body weight in the first year and 19% loss of total body weight after five years.
  • Adjustable gastric banding led to a 14% total weight loss after a year and 12% at five years.

For the average person in this study, there was a 19-pound (8.6kg) weight loss difference between the bypass and sleeve procedures after five years. The average person in this study weighed 277 pounds (125.6kg) before surgery, the researchers said.

Complications measured in study

But the 30-day rate of serious complications for gastric bypass was nearly double the risk of the sleeve procedure. The rate of complications in the 30-day period after surgery was 5% for gastric bypass, 2.6% for sleeve gastrectomy and 2.9% for adjustable gastric banding.

The complications measured in the study included death, reoperation/repair procedures, clots, or failure to be discharged from the hospital within 30 days.

Gastric bypass and sleeve gastrectomy are similar in terms of cost, according to Arterburn. Each procedure averages between $20,000 and $30,000, he estimated. Adjustable gastric banding is less expensive and may average around $15,000, he noted. Insurance coverage for these procedures varies quite a bit, and not all will cover weight-loss surgery.

Dr Mitchell Roslin, director of the bariatric surgery programme at Northern Westchester Hospital in Mount Kisco, New York, said that people shouldn't only focus on the total weight loss when trying to select a procedure.

"There is no perfect way. The more we change the body, the higher the weight loss, but complications may be higher. There's no one-size-fits-all weight-loss surgery," said Roslin, who wasn't involved with the study.

"The decision really requires detailed conversation and education. You need to understand your own individual medical issues and objectives," he said.

Arterburn added that people should look for a surgeon that has experience in multiple weight-loss procedures.

"Not every surgeon is equally comfortable with all of the procedures. Have a conversation with a surgeon who does all of the surgeries so the conversation is about what's right for you," he said.

The findings were published in the Annals of Internal Medicine.

Image credit: iStock




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