Factors influencing patient choice for bariatric operation

Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience

BACKGROUND

Rapid adoption of sleeve gastrectomy (SG) in the last decade aptly reflects the desire of patients and surgeons for alternatives to RYGB and DS. While SG provides good outcomes, other options that address specific patient needs are warranted. Recently approved by ASMBS, SADI, and OAGB have garnered increasing interest due to their single anastomosis technique.

METHODS

Using the Metabolic and Bariatric Surgery Quality Improvement Program database, we examined laparoscopic and robotic cases from 2018 to 2021 to understand the percentage of primary bariatric surgery cases that are SADI and OAGB. We used coarsened exact matching to match patients who underwent SADI or OAGB to patients who underwent Roux-en-Y gastric bypass (RYGB). We examined outcomes of matched patients using logistic regression.

RESULTS

Of the 667,979 patients that underwent bariatric-metabolic surgery, 1326 (0.2%) underwent SADI, and 2541 (0.4%) underwent OAGB. SADI was not identified in the database until 2020. In 2020, there were 487 SADI procedures compared to 839 in 2021. From 2018 to 2021, OAGBs went from 149 to 940. Compared with RYGB, SADI was associated with higher rates of anastomotic or staple line leak (OR 2.21 (95% CI 1.08-4.53)) and sepsis (OR 3.62 (95% CI 1.62-8.12)). Compared with RYGB, OAGB was associated with lower rates of gastrointestinal bleeding (OR 0.29 (95% CI 0.12-0.71)) and bowel obstruction (OR 0.10 (95% CI 0.02-0.39)). Of note, there were no differences between these procedures and RYGB for 30-day mortality.

CONCLUSION

More SADIs and OAGBs are being performed. However, there were higher complication rates associated with the SADI procedure. Further studies will be needed to better understand the key drivers for these outcomes.

Hospital Variation in Preference for a Specific Bariatric Procedure and the Association with Weight Loss Performance: a Nationwide Analysis

PURPOSE

Hospitals performing a certain bariatric procedure in high volumes may have better outcomes. However, they could also have worse outcomes for some patients who are better off receiving another procedure. This study evaluates the effect of hospital preference for a specific type of bariatric procedure on their overall weight loss results.

METHODS

All hospitals performing bariatric surgery were included from the nationwide Dutch Audit for Treatment of Obesity. For each hospital, the expected (E) numbers of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB) were calculated given their patient-mix. These were compared with the observed (O) numbers as the O/E ratio in a funnel plot. The 95% control intervals were used to identify outlier hospitals performing a certain procedure significantly more often than expected given their patient-mix (defined as hospital preference for that procedure). Similarly, funnel plots were created for the outcome of patients achieving ≥ 25% total weight loss (TWL) after 2 years, which was linked to each hospital's preference.

RESULTS

A total of 34,558 patients were included, with 23,154 patients completing a 2-year follow-up, of whom 79.6% achieved ≥ 25%TWL. Nine hospitals had a preference for RYGB (range O/E ratio [1.09-1.53]), with 1 having significantly more patients achieving ≥ 25%TWL (O/E ratio [1.06]). Of 6 hospitals with a preference for SG (range O/E ratio [1.10-2.71]), one hospital had significantly fewer patients achieving ≥ 25%TWL (O/E ratio [0.90]), and from two hospitals with a preference for OAGB (range O/E ratio [4.0-6.0]), one had significantly more patients achieving ≥ 25%TWL (O/E ratio [1.07]). One hospital had no preference for any procedure but did have significantly more patients achieving ≥ 25%TWL (O/E ratio [1.10]).

CONCLUSION

Hospital preference is not consistently associated with better overall weight loss results. This suggests that even though experience with a procedure may be slightly less in hospitals not having a preference, it is still sufficient to achieve similar weight loss outcomes when surgery is provided in centralized high-volume bariatric institutions.

Is development in bariatric surgery in Germany compatible with international standards? A review of 16 years of data

Bariatric surgery has expanded tremendously internationally over the past decade. In recent years, bariatric surgery has experienced a significant growth in Germany. However, the question arises as to whether this development is in line with international developments or whether there is still room for improvement that could be challenged. 63,990 primary bariatric procedures recorded in the German Bariatric Surgery Registry (GBSR) were analyzed from 2005 to April 2021. The distribution of procedures according to different variants was analyzed and presented. In the last 16 years, 17 different procedures have been performed. The most common surgical procedure was sleeve gastrectomy (SG), followed by Roux-Y gastric bypass (RYGB) (42%). Adjustable gastric banding (AGB) has declined over time, from 23.5% in the first 5 years to 0.2% in recent years. In comparison, omega-loop gastric bypass has increased over the past 5 years (from 0.4% in the first 5 years to 5.9% in the last 5 years). Laparoscopic procedures have accounted for 96.4% of all bariatric surgeries in recent years. The frequency of some procedures has decreased and some bariatric procedures have lost significance. Overall, bariatric surgery in Germany has developed positively compared to the international trend. Nevertheless, there is one area that needs to be optimized: the development of robotic bariatric surgery, which crawls behind in Germany compared to other countries. To establish the technology in bariatric surgery in a timely manner, a balance must be found between cost neutrality and patient-oriented applications.

Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment

BACKGROUND

Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences.

OBJECTIVE

To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences.

SETTING

Online survey.

METHODS

A discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations.

RESULTS

Respondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients.

CONCLUSIONS

Results show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs.

Patient preferences regarding bariatric/metabolic procedures: a survey of Korean obese candidates for surgery

Purpose

The objective of this study was to survey potential candidates for bariatric/metabolic surgery for procedure preferences.

Methods

Questions asked were divided into 5 categories: (1) demographic and anthropometric data, comorbidities, and favored surgery; (2) awareness of safety, effectiveness, and complications of each type of surgery; (3) discordances in opinion between self-selected and medically recommended procedures; and (4, 5) reasons for/against particular surgery.

Results

From 1 October to 15 November 2018, 104 respondents adequately responded and were included in the analysis. The number (%) of female respondents was 79 (76.0%). The number (%) of respondents by decade was 17 (16.3%) in their 20s, 65 (62.5%) in their 30s, 19 (18.3%) in their 40s, and 3 (2.9%) in their 60s, respectively. Mean body mass index was 37.1 ± 6.3 kg/m². Comorbidities were type 2 diabetes in 34 (32.7%) and hypertension in 35 (33.7%). The most favored procedure was sleeve gastrectomy (SG) in 78 (75.0%), adjustable gastric band (AGB) surgery in 12 (11.5%), Roux-en-Y gastric bypass (RYGB) in 6 (5.8%), and gastric plication (GP) in 8 (7.7%). Major reasons for choosing procedures were; “adjustable” for AGB, “stomach sparing” for GP, “excellent weight loss” for SG, and “comorbidity resolution” in RYGB.

Conclusion

Candidates for bariatric/metabolic surgery favored SG followed by AGB, GP, and RYGB, and their choices were compatible with current evidence-based clinical practice.

Patient Preferences for Bariatric Surgery: Findings From a Survey Using Discrete Choice Experiment Methodology

Importance

Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown.

Objective

To identify patient preferences for risks, benefits, and other attributes of treatment options available to individuals who are candidates for bariatric surgery.

Design, Setting, and Participants

This discrete choice experiment of weight loss procedures was performed as an internet-based survey administered to patients recruited from bariatric surgery information sessions in the State of Michigan. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) time that treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) adverse effects, (8) changes to diet, and (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. Survey data were collected from May 1, 2015, through January 30, 2016, and analyzed from February 1 to June 30, 2016.

Main Outcomes and Measures

Estimated relative value of risks and benefits for leading weight-loss surgical options and marginal willingness to pay for procedure attributes. A latent class analysis identified respondent subgroups.

Results

Among the 815 respondents (79.9% women; mean [SD] age, 44.5 [12.0] years), profiles of hypothetical procedures that included resolution of medical conditions (coefficient for full resolution, 0.229 [95% CI, 0.177 to 0.280; P < .001]; coefficient for no resolution, -0.207 [95% CI, -0.254 to -0.159; P < .001]), higher total weight loss (coefficient for each additional 20% loss, 0.185 [95% CI, 0.166 to 0.205; P < .001]), and lower out-of-pocket costs (coefficient for each additional $1000, -0.034 [95% CI, -0.042 to -0.025; P < .001]) were most likely to be selected. Younger respondents were more likely than older respondents to choose treatments with higher weight loss (coefficient for loss of 80% excess weight 0.543 [95% CI, 0.435-0.651] vs 0.397 [95% CI, 0.315-0.482]) and were more sensitive to out-of-pocket costs (coefficient for $100 out-of-pocket costs, 0.346 [95% CI, 0.221-0.470] vs 0.262 [95% CI, 0.174 to 0.350]; coefficient for $15 000 in out-of-pocket costs, -0.768 [95% CI, -0.938 to -0.598] vs -0.384 [95% CI, -0.500 to -0.268]). Marginal willingness to pay indicated respondents would pay $5470 for losing each additional 20% of excess body weight and $12 843 for resolution of existing medical conditions, the most desired procedure attributes. Latent class analysis identified the following 3 unobserved subgroups: cost-sensitive (most concerned with costs); benefit-focused (most concerned with excess weight loss and resolution of medical conditions); and procedure-focused (most concerned with how the treatment itself worked, including recovery and reversibility).

Conclusions and Relevance

Candidates for bariatric surgery identified costs, expected weight loss, and resolution of medical conditions as the most important characteristics of weight loss surgery decisions. Other information, such as risk of complications and adverse effects, were important to patients but less so.

Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference?

BACKGROUND

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted.

OBJECTIVE

To evaluate preferences for RYGB versus SG.

SETTING

Survey of U.S. adults.

METHODS

An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information.

RESULTS

Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m² (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%).

CONCLUSIONS

Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.

Patient preferences and bariatric surgery procedure selection; the need for shared decision-making

BACKGROUND

Bariatric surgery is the most effective treatment for patients suffering from obesity-related comorbidities. There is little data regarding how patients choose one particular bariatric procedure over another. This study aimed to better define the relationship between preferences of patients considering bariatric surgery and the procedure patients undergo.

METHODS

A bilingual questionnaire was administered to all prospective patients seen between March 1 and August 31, 2012. The questionnaire assessed basic knowledge of bariatric surgery (based on the information seminar) as well as patient preferences of the various outcomes and complications for sleeve gastrectomy, gastric bypass, and gastric banding.

RESULTS

One hundred seventy-two patients completed the questionnaire. Fifty-eight percent of patients chose "maximum weight loss" as the most important outcome, and 65 % chose "leak" as the most concerning complication. Subgroup analysis of patients with diabetes revealed that 58 % chose "curing diabetes" as the most important outcome. Nineteen percent of patients were either not sure which procedure they wanted or changed their decision after consultation with the surgeon.

CONCLUSIONS

The decision to choose one bariatric procedure over another is complex and is based on factors beyond absolute patient preferences. Although maximum weight loss is a commonly reported preference for patients seeking bariatric surgery, patients with diabetes are more focused on diabetes remission. Most patients have already decided which procedure to undergo prior to surgeon consultation. Patients may benefit from shared decision making, which integrates patient values and preferences along with current medical evidence to assist in the complex bariatric surgery selection process.

Psychological assessments of bariatric surgery patients. Development, reliability, and exploratory factor analysis of the PsyBari

BACKGROUND

Bariatric surgery patients are required to receive psychological clearance before they are eligible for surgery. In spite of this, there are no standard assessment practices or tests designed specifically for these evaluations.

OBJECTIVE

The objective of this study is to determine the reliability and construct validity of the PsyBari, a psychological test designed for bariatric surgery patients.

METHODS

The PsyBari was administered to 752 patients. Internal consistency reliability and exploratory factor analyses were conducted.

RESULTS

Items with high percentages of missing data, low communalities, and low item loadings were identified and deleted. Cronbach's α = 0.930 (0.940 for males and 0.927 for females). Six factors were obtained for each gender: for females, awareness of eating habits, early life problems due to weight, dysphoric feelings about weight, weight-related impairment, surgical anxiety, and guilty feelings related to eating; for males, physical impairment with depression, awareness of eating habits, early life problems due to weight, interpersonal support with anxiety about weight, anger, and guilty feelings about eating habits.

CONCLUSIONS

Results indicate that there are unique psychometric parameters when constructing tests for bariatric surgery patients. The PsyBari has good overall reliability, although two of the 11 subscales have poor reliability. Factor analyses revealed six factors for each gender. Some factors were common for both genders, some were unique for each gender, and some consisted of mixed constructs.

Psychological risk may influence drop-out prior to bariatric surgery

BACKGROUND

Factors necessitating a delay before psychological clearance for bariatric surgery have been previously identified; however, research has not examined why patients who begin the preoperative evaluation fail to complete surgery or drop-out of bariatric programs. This study sought to explore the potential psychosocial reasons for a failure to reach bariatric surgery. The setting was an academic medical center.

METHODS

Data were analyzed from 129 patients psychologically evaluated for bariatric surgery who had failed to reach surgery after 15 months. Medical records were reviewed for demographics, body mass index, and psychiatric variables.

RESULTS

The most common reasons for not reaching surgery included withdrawal from the program, outstanding program requirements, self-canceled surgery, moving out of the area, insurance denial, switching to non-surgical weight management, or death. Patients with outstanding program requirements were psychosocially different from patients who had not achieved surgery for other reasons. They were significantly more likely to be involved in outpatient behavioral health treatment (chi-square = 12.90, P < .05), to be taking psychotropic medications (chi-square = 15.17, P < .05), and to have met the criteria for current or past alcohol abuse/dependence (chi-square = 23.70, P < .01), and there was a trend for previous inpatient hospitalizations (chi-square = 11.59, P < .07).

CONCLUSION

Patients who failed to complete outstanding program requirements often had significant psychiatric and/or substance abuse/dependence issues that required additional treatment. It is possible that these patients drop-out of the program due to unwillingness to complete psychiatric treatment recommendations. Continued screening of high-risk patients and the education of patients on the importance of managing these risks is indicated. However, patients may choose to leave programs once education has been provided or treatment mandated.

Do patients seeking laparoscopic adjustable gastric banding surgery differ from those seeking gastric bypass surgery? A comparison of psychological profiles across ethnic groups

BACKGROUND

Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients.

METHODS

Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation.

RESULTS

RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients.

CONCLUSIONS

Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.

Bariatric surgery in Australia: who, why and how?

A review of published reports was conducted to identify gaps in the research regarding bariatric surgery. Much of the research that has been conducted is clinical outcome based; however, little research has been conducted in many key areas. Data on the demographics of the bariatric surgery group are patchy at best. The role of best practice and evidence-based medicine in bariatric surgery seems to be poorly understood, and equity issues and the role of clinical pathways in bariatric surgery need to be clarified. Significant gaps were identified in the published reports regarding pathways to bariatric surgery and multidisciplinary team use. Additionally, much of the published report and research data were from US studies, as few Australian studies have been conducted. Further research and policy and practice developments in bariatric surgery are needed, especially with regard to the Australian context.

Surgery versus radioiodine therapy as definitive management for graves' disease: the role of patient preference

BACKGROUND

Thyroidectomy is an option for the definitive management of Graves' disease. The aim of this study was to examine the role of patient preference for selecting surgery as definitive treatment.

PATIENTS AND METHODS

This is a retrospective cohort study comprising all patients (n = 63) presenting to a single surgeon for surgical management of Graves' disease over 3 years. Documented reasons for surgery were compared with accepted indications, as well as patients' perceptions as assessed by questionnaire.

RESULTS

The most frequent absolute indication was the presence of a large goiter (n = 8; 13%) or associated thyroid nodule (n = 6; 10%). Ophthalmopathy, a relative indication, comprised the largest single group overall (n = 18; 29%); however, a significant number of patients (n = 17; 27%) elected surgery in the absence of a recognized indication. There was strong concordance (73%) between the recorded indication and the patients' survey response. Overall, there was a high level of satisfaction with surgery with 88% of respondents giving a satisfaction score of 7 or greater on a visual analog scale (VAS) (0-10).

CONCLUSIONS

One-third of all patients electing surgery as definitive management do so in the absence of a specific indication. Overall, there is a high level of satisfaction with the decision for surgery as definitive management of Graves' disease.

Laparoscopic adjustable gastric banding for patients with body mass index of <or=35 kg/m2

BACKGROUND

Many mild-to-moderately obese individuals (body mass index [BMI] 30-35 kg/m(2)) have serious diseases related to their obesity. Nonoperative therapy is ineffective in the long term, yet surgery has never been made widely available to this population.

METHODS

Between 1996 and 2004, 93 patients with a BMI of 30-35 kg/m(2) underwent laparoscopic adjustable gastric banding with the LAP-BAND. All patients were referred by their primary physician, entered into a comprehensive bariatric surgery program at one Australian center, and operated on by one surgeon. Data on all patients were collected prospectively and entered into an electronic registry. The study parameters included preoperative age, gender, BMI, presence of co-morbidities, percentage of excess weight loss, and resolution of co-morbidities.

RESULTS

The mean age was 44.6 years (range 16-76), mean weight was 98 kg, and the mean BMI was 32.7 kg/m(2) (range 30-34). Of the 93 patients, 42 (45%) had co-morbidities, including asthma, diabetes, hypertension, and sleep apnea. The proportion of patients in follow-up was 79%, 85%, and 89% at 1, 2, and 3 years, respectively. The mean weight was reduced to 71 kg at 1 year, 72 kg at 2 years, and 72 kg at 3 years. The mean BMI was reduced to 27.2 +/- 2.2, 27.3 +/- 3.1, and 27.6 +/- 3.7 kg/m(2), respectively, and the mean percentage of excess weight loss was 57.9% +/- 24.5%, 57.6 +/- 29.3%, and 53.8% +/- 32.8% at 1, 2, and 3 years, respectively. At 3 years, the BMI was 18-24 kg/m(2) in 34%, 25-29 kg/m(2) in 51%, and 30-35 kg/m(2) in 10%. At 3 years, the percentage of excess weight loss was <25% in 10%, 25-50% in 24%, 50-75% in 51%, and >75% in 10%. The co-morbidities improved or completely resolved in most patients. No mortality occurred.

CONCLUSION

We are very encouraged by this series of low BMI patients treated with the LAP-BAND. Their weight loss has been good, the complications have been minimal, and the co-morbidities have partially or wholly resolved. With additional study, it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30-35 kg/m(2).

Laparoscopic bariatric surgery

Laparoscopy has meant profound changes for the field of bariatric surgery. Bariatric operations, which are technically difficult because of the patient population, were not performed laparoscopically until the last 5 years of the 20th century. The years 1998 to 2003, herein defined as the Bariatric Revolution, saw profound changes in the way bariartric surgery was practiced. Major changes in patient education, public awareness, patient enthusiasm, popularity of the surgery, and academic acceptance of bariatric surgery occurred during this time. This led to such a massive increase in procedures performed that there was a reactionary movement by insurers to deny coverage for these procedures. Limitation of access to care and other important socioeconomic issues are now being debated and confronted in the bariatric arena. Recommendations for the field are suggested. The outcomes of these controversies will potentially have a profound impact on all of surgery.

Objective Comparison of Complications Resulting from Laparoscopic Bariatric Procedures

BACKGROUND

Several surgical treatment options for morbid obesity exist. Currently, there are no studies that objectively compare complication rates after laparoscopic bariatric operations performed at a single institution. We objectively classify and compare complications resulting from laparoscopic adjustable gastric banding (LABG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD) with duodenal switch (DS).

STUDY DESIGN

A retrospective review of a prospective database of all patients undergoing laparoscopic bariatric operation was performed. Complications were categorized according to severity score using a well-described classification system and compared between procedures.

RESULTS

From September 2000 to July 2003, 780 laparoscopic bariatric operations were performed: 480 LAGB, 235 RYGB, and 65 BPD+/-DS. There was one late death. Total complication rates were: 9% for LAGB, 23% for RYGB, and 25% for BPD+/-DS. Complications resulting in organ resection, irreversible deficits, and death (grades III and IV) occurred at rates of 0.2% for LAGB, 2% for RYGB, and 5% for BPD+/-DS. LAGB group had a statistically significant lower overall complication rate, both by incidence and severity, as compared with other groups (p < 0.001). After controlling for differences of admission body mass index, gender, and race, the LAGB group had an almost three and a half times lower likelihood of a complication compared with the RYGB group (odds ratio, 3.4; 95% CI, 2.2-5.3, p < 0.001) and had an over three and a half times lower likelihood of a complication compared with the BPD with DS group (odds ratio, 3.6; 95% CI, 1.8-7.1, p < 0.001). There was no statistically significant difference between complication rates of RYGB and BPD+/-DS.

CONCLUSIONS

Bariatric operation complication rates range from 9% to 25%; very few complications are serious. Laparoscopic adjustable gastric banding is the safest operation in terms of complication rate and severity when compared with laparoscopic Roux-en-Y gastric bypass or laparoscopic malabsorptive operations.

Early U.S. outcomes of laparoscopic gastric bypass versus laparoscopic adjustable silicone gastric banding for morbid obesity

Laparoscopic gastric bypass (LGBP) is the gold standard operation for long-term weight control in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) is the preferred operative method for morbid obesity worldwide. Limited data are available comparing the two procedure in the United States. This study compares weight loss, complications, and early outcome of comorbidity resolution in patients who underwent LGBP versus LASGB. A review of prospectively collected data was performed on 392 patients undergoing primary LGBP (n = 232) and LASGB (n = 160) procedures between February 2001 and July 2004. Differences in percentage excess weight lost (%EWL) at 3, 6, 12, 18, and 24 months postop, improvement or resolution of comorbidities, and complications across procedure types were evaluated. Mean initial body mass index between groups was not significantly different (LGBP 47.2 vs LASGB 47.1, p < 0.53). There were significant differences in age, gender, and self-reported sweet-eating behavior between operative groups. There was a significantly greater %EWL in patients who underwent LGBP compared to patients of the LASGB groups 3, 6, 12, and 18 months after surgery. There were no significant differences in resolution or improvement of comorbidities between the groups. Although LGBP patients experienced more complications compared to LASGB patients (5.6 vs 4.3%, respectively; p < 0.56), this did not reach statistical significance. Early after surgery, LGBP patients lose more weight than LASGB patients but have similar improvements in comorbidities. Further follow-up is needed to determine the relative long-term efficacy of these procedures.