Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients - A prospective, comparative analysis

Hypothesis: Outcome following laparoscopic adjustable gastric banding (LAGB) in super morbidly obese patients is significantly worse compared with the standard laparoscopic Roux-en-Y gastric bypass (LRYGB). Design: Prospective case series. Setting: Community teaching hospital (490 beds) Patients: A prospectively maintained database identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004. The study group included super morbidly obese patients (body mass index > 50 [calculated as weight in kilograms divided by the square of height in meters]) following LAGB and LRYGB. Interventions: Among 106 patients with super morbid obesity, 60 (57%) and 46 (43%) underwent LAGB and LRYGB, respectively. Main Outcome Measures: Patient demographics, weight loss, percentage of excess weight loss, change in body mass index, early (< 30 days) and late (>= 30 days) complications, reoperations, medical comorbidity, and patient satisfaction were studied. Analysis was performed using the t test and Pearson chi(2) analysis. Results: Overall median follow-up was 16.2 months (range, 1-40 months). Preoperative factors of patient age, sex, weight, body mass index, and medical comorbidity were similar between the 2 groups. Compared with LRYGB, patients who underwent LAGB experienced a greater incidence of late complications (P <.05), reoperations (P <.04), less weight loss (P <.001), and decreased overall satisfaction (P <.006). Likewise, patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus (P <.05) and sleep apnea (P <.01) compared with the LAGB group. Furthermore, postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations. Our single mortality was in the LAGB group. Conclusions: In super morbidly obese patients, LAGB is significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity, and patient dissatisfaction compared with LRYGB. Further evaluation of LAGB in this patient population appears warranted.