pmc logo image
Logo of annsurgJournal URL: http://www.annalsofsurgery.com
Journal List > Ann Surg > v.205(6); Jun 1987

Formats:
Ann Surg. 1987 June; 205(6): 613–624.
PMCID: PMC1493086
Copyright notice
A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.
H J Sugerman, J V Starkey, and R Birkenhauer
Small right arrow pointing to: See "Discussion" on page 622.
 
Small right arrow pointing to: This article has been cited by other articles in PMC.
Abstract
Vertical banded gastroplasty (VBGP) was compared with Roux-en-Y gastric bypass (RYGBP) in a randomized prospective trial that included preoperative dietary separation of "sweets eaters" versus "non-sweets eaters." Randomization was stopped at 9 months after 20 patients had undergone each procedure because a greater weight loss (p less than 0.05) was noted after RYGBP than VBGP. This difference became more significant (p less than 0.001) at each 3-month interval through 3 years, when patients who had VBGPs had lost 37 +/- 20% of excess weight compared with 64 +/- 19% for patients who had RYGBPs. The members of the groups were comparable with regard to age, sex, eating habits, morbidity rates before surgery, ideal body weight, and weight before surgery. Although there was no significant difference between the loss of excess weight in "sweets eaters" (69 +/- 17%) or "non-sweets eaters" (67 +/- 17%) after RYGBP at 1 year, "sweets eaters" who had VBGPs lost significantly less excess weight (36 +/- 13%) than did "non-sweets eaters" who had VBGPs (57 +/- 18%), p less than 0.02, or "sweets eaters" who had RYGBPs, p less than 0.0001. No significant differences were noted for electrolytes, renal or liver function tests, and most vitamins between patients who had VBGPs and RYGBPs; however, patients who had RYGBPs had lower (p less than 0.05) serum vitamin B12 levels (286 +/- 149 pg/dl) than did patients who had VBGPs (461 +/- 226 pg/dl) at 2 years. By 3 years, the vitamin B12 levels were equal in members of the two groups. Five patients who had RYGBPs required endoscopic stomal dilatation for stomal stenosis and one had a marginal ulcer develop, which responded to cimetidine. RYGBP was clearly superior to VBGP for "sweets eaters," probably because of the development of dumping syndrome symptoms. However, RYGBP was associated with a larger number of correctable problems. Thus, it is important to evaluate a patient's eating habits before surgery for morbid obesity; "non-sweets eaters" probably should be treated with VBGP and "sweets eaters" with RYGBP.
Full text
Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
 
icon of scanned page 613
613
icon of scanned page 614
614
icon of scanned page 615
615
icon of scanned page 616
616
icon of scanned page 617
617
icon of scanned page 618
618
icon of scanned page 619
619
icon of scanned page 620
620
icon of scanned page 621
621
icon of scanned page 622
622
 
Images in this article
Fig. 6.
Fig. 6.

Fig. 6.
on p.618
Fig. 7.
Fig. 7.

Fig. 7.
on p.619
Fig. 8.
Fig. 8.

Fig. 8.
on p.619
Click on the image to see a larger version.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
  • Drenick EJ, Bale GS, Seltzer F, Johnson DG. Excessive mortality and causes of death in morbidly obese men. JAMA. 1980 Feb 1;243(5):443–445. [PubMed]
  • Van Itallie TB. Obesity: adverse effects on health and longevity. Am J Clin Nutr. 1979 Dec;32(12 Suppl):2723–2733. [PubMed]
  • Lew EA, Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979;32(8):563–576. [PubMed]
  • Sugerman HJ, Fairman RP, Baron PL, Kwentus JA. Gastric surgery for respiratory insufficiency of obesity. Chest. 1986 Jul;90(1):81–86. [PubMed]
  • Drenick EJ. Definition and health consequences of morbid obesity. Surg Clin North Am. 1979 Dec;59(6):963–976. [PubMed]
  • Corbett JJ, Mehta MP. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology. 1983 Oct;33(10):1386–1388. [PubMed]
  • Hackel F, Voigt H, Hänisch HC, Grosser L. Ergebnisse der Wurzener Studie 1971: Zur Epidemiologie der Venenerkrankungen bei Männern. Z Gesamte Inn Med. 1974 Aug 1;29(15):611–616. [PubMed]
  • Goldin RH, McAdam L, Louie JS, Gold R, Bluestone R. Clinical and radiological survey of the incidence of osteoarthrosis among obese patients. Ann Rheum Dis. 1976 Aug;35(4):349–353. [PubMed]
  • Wadden TA, Stunkard AJ. Social and psychological consequences of obesity. Ann Intern Med. 1985 Dec;103(6 ():1062–1067. [PubMed]
  • Johnson D, Drenick EJ. Therapeutic fasting in morbid obesity. Arch Intern Med. 1977 Oct;137(10):1381–1382. [PubMed]
  • Jewell WR, Hermreck AS, Hardin CA. Complications of jejunoileal bypass for morbid obesity. Arch Surg. 1975 Aug;110(8):1039–1042. [PubMed]
  • Halverson JD, Wise L, Wazna MF, Ballinger WF. Jejunoileal bypass for morbid obesity. A critical appraisal. Am J Med. 1978 Mar;64(3):461–475. [PubMed]
  • Hocking MP, Duerson MC, O'Leary JP, Woodward ER. Jejunoileal bypass for morbid obesity. Late follow-up in 100 cases. N Engl J Med. 1983 Apr 28;308(17):995–999. [PubMed]
  • Griffen WO, Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977 Oct;186(4):500–509. [PubMed]
  • Buckwalter JA. A prospective comparison of the jejunoileal and gastric bypass operations for morbid obesity. World J Surg. 1977 Nov;1(6):757–768. [PubMed]
  • Rucker RD, Jr, Horstmann J, Schneider PD, Varco RL, Buchwald H. Comparisons between jejunoileal and gastric bypass operations for morbid obesity. Surgery. 1982 Aug;92(2):241–249. [PubMed]
  • Alden JF. Gastric and jejunoileal bypass. A comparison in the treatment of morbid obesity. Arch Surg. 1977 Jul;112(7):799–806. [PubMed]
  • Pace WG, Martin EW, Jr, Tetirick T, Fabri PJ, Carey LC. Gastric partitioning for morbid obesity. Ann Surg. 1979 Sep;190(3):392–400. [PubMed]
  • Gomez CA. Gastroplasty in morbid obesity. Surg Clin North Am. 1979 Dec;59(6):1113–1120. [PubMed]
  • Pories WJ, Flickinger EG, Meelheim D, Van Rij AM, Thomas FT. The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion. Ann Surg. 1982 Oct;196(4):389–399. [PubMed]
  • Lechner GW, Elliott DW. Comparison of weight loss after gastric exclusion and partitioning. Arch Surg. 1983 Jun;118(6):685–692. [PubMed]
  • Freeman JB, Burchett HJ. A comparison of gastric bypass and gastroplasty for morbid obesity. Surgery. 1980 Sep;88(3):433–444. [PubMed]
  • Linner JH. Comparative effectiveness of gastric bypass and gastroplasty: a clinical study. Arch Surg. 1982 May;117(5):695–700. [PubMed]
  • Laws HL, Piantadosi S. Superior gastric reduction procedure for morbid obesity: a prospective, randomized trial. Ann Surg. 1981 Mar;193(3):334–340. [PubMed]
  • Sugerman HJ, Wolper JL. Failed gastroplasty for morbid obesity. Revised gastroplasty versus Roux-Y gastric bypass. Am J Surg. 1984 Sep;148(3):331–336. [PubMed]
  • Eckhauser FE, Knol JA, Strodel WE. Remedial surgery following failed gastroplasty for morbid obesity. Ann Surg. 1983 Nov;198(5):585–591. [PubMed]
  • Mason EE. Vertical banded gastroplasty for obesity. Arch Surg. 1982 May;117(5):701–706. [PubMed]
  • Stunkard AJ, Waxman M. Accuracy of self-reports of food intake. J Am Diet Assoc. 1981 Nov;79(5):547–551. [PubMed]
  • Campbell C, Roe DA, Eickwort K. Qualitative diet indexes: a descriptive or an assessment tool? J Am Diet Assoc. 1982 Dec;81(6):687–694. [PubMed]
  • Perloff JK, Stevenson WG, Roberts NK, Cabeen W, Weiss J. Cardiac involvement in myotonic muscular dystrophy (Steinert's disease): a prospective study of 25 patients. Am J Cardiol. 1984 Nov 1;54(8):1074–1081. [PubMed]
  • Wolper JC, Messmer JM, Turner MA, Sugerman HJ. Endoscopic dilation of late stomal stenosis. Its use following gastric surgery for morbid obesity. Arch Surg. 1984 Jul;119(7):836–837. [PubMed]
  • Deitel M, Jones BA, Petrov I, Wlodarczyk SR, Basi S. Vertical banded gastroplasty: results in 233 patients. Can J Surg. 1986 Sep;29(5):322–324. [PubMed]
  • Makarewicz PA, Freeman JB, Burchett H, Brazeau P. Vertical banded gastroplasty: assessment of efficacy. Surgery. 1985 Oct;98(4):700–707. [PubMed]
  • Eckhout GV, Willbanks OL, Moore JT. Vertical ring gastroplasty for morbid obesity. Five year experience with 1,463 patients. Am J Surg. 1986 Dec;152(6):713–716. [PubMed]
  • Halverson JD, Koehler RE. Gastric bypass: analysis of weight loss and factors determining success. Surgery. 1981 Sep;90(3):446–455. [PubMed]
  • Scopinaro N, Bachi V. Evoluzione del bypass biliopancreatico parziale per l'obesità. Minerva Chir. 1984 Oct 15;39(19):1299–1305. [PubMed]
  • MacLean LD, Rhode BM, Shizgal HM. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983 Sep;198(3):347–355. [PubMed]
  • Amaral JF, Thompson WR, Caldwell MD, Martin HF, Randall HT. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985 Feb;201(2):186–193. [PubMed]
  • Rasmussen LH, Andersen T. The relationship between QTc changes and nutrition during weight loss after gastroplasty. Acta Med Scand. 1985;217(3):271–275. [PubMed]
Articles from Annals of Surgery are provided here courtesy of
Lippincott, Williams, and Wilkins

PubMed articles by these authors