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JAMA Surg. 2014 Dec;149(12):1279-87. doi: 10.1001/jamasurg.2014.1674.

Comparative effectiveness of laparoscopic adjustable gastric banding vs laparoscopic gastric bypass.

Author information

1
Group Health Research Institute, Seattle, Washington.
2
Kaiser Permanente Colorado Institute for Health Research, Denver.
3
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
4
University of Colorado School of Medicine, Aurora.
5
Kaiser Permanente Georgia Center for Health Research Southeast, Atlanta.
6
University of Colorado School of Medicine, Aurora6Colorado Permanente Medical Group, Aurora.
7
Kaiser Permanente Division of Research, Oakland, California.
8
University of Hawai'i at Manoa, Honolulu.
9
Kaiser Permanente Hawaii Center for Health Research, Honolulu.
10
Kaiser Permanente, Oakland, California.

Abstract

IMPORTANCE:

Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures.

OBJECTIVE:

To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes.

DESIGN, SETTING, AND PARTICIPANTS:

A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States.

MAIN OUTCOMES AND MEASURES:

The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention.

RESULTS:

We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score-adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively.

CONCLUSIONS AND RELEVANCE:

In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.

PMID:
25353723
DOI:
10.1001/jamasurg.2014.1674
[Indexed for MEDLINE]

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