gastric bypass, the most commonly performed surgery for obesity in U.S., seems to help patients lose more weight and can treat diabetes more effectively than newer techniques, two studies show.
The studies, which are published in the surgery files, compared the traditional gastric bypass for two most recent interventions - laparoscopic gastric band (band back) and mango gastrectomy.In both studies, bypass offered more dramatic results, perhaps because the procedure constitutes digestion, ignoring a portion of the small intestine. Experts say studies show why it is important for people to consider weight loss surgery to understand trade-offs.
"The band back has fewer complications and is general a safer procedure," says Harry C. Sax, MD, a Bariatric surgeon at Warren Alpert Medicine School in Brown University in Providence, RI ", however , the weight loss of the band back is more modest, and we are not clear as they will be durable. "
"In some cases, the riskier procedure, ie the gastric BYPAS Roux-en-en-y, can offer greater benefits. This is certainly some of the data that are coming out looking for diabetes management," he says. Sax, who wrote a perspective that followed the studies.
Effective Diet For Fat Loss - Gastric Bypass: Most Effective Weight Loss Surgery?
"It's very clear: Bypass is better than the band, period. Bypass solves more diabetes than the band, period. And if you are diabetic with obesity, the best treatment is roux-en-y gastric bypass", Says the study researcher Guilherme M. Campos, MD, a Bariatric surgeon who is now with the University of Wisconsin School of Medicine and Public Health in Madison.
fields notes that their study included only patients who had BMIS in 35, but that the FDA recently approved the band procedure back to people with BMIs as low as 30 that also had at least another medical condition related to obesity . / p>.
"I think for patients with the lowest IMC level, it may be worth considering laparoscopic bands as an option," he says.
Cathy Taylor, Senior Corporate Communications Manager at Allergan Inc., writes in an email for WebMD, "This is a single center study, not a randomized, double-blind and multi-center clinical trial, and the study conclusions are aligned with the vast findings of published literature. The band system procedure is inherently safer than the gastric bypass, bypass is an invasive procedure ... In addition, the medical literature supports that in five years that is The measurement of sustainable weight loss, weight loss achieved with the band system is in pair with weight loss reached from the gastric bypass. In terms of diabetes resolution, a reference study published in Jama in 2008 discovered that The gastric band also helps to solve the diabetes over time. "
For the second study, the researchers in Taiwan recruited 60 moderately obese patients (BMIS between 25 and 35) that had poorly controlled type 2 diabetes. They randomly attributed half of the patients to obtain gastric deviation. The other half had a sleeve gastrectomy, which involves surgically removal a part of the stomach, creating a small "sleeve" of the stomach on as a garden hose. In this procedure there is no small intestine bypass.
After 12 months, double patients in the gastric bypass group (93%) saw their diabetes resolve compared to those who had sleeve gastrectomies (47%). The bypass group also lost more weight, had blood glucose levels and had better total levels and LDL cholesterol than the group of gastrectomy, a discovery that surprised researchers.
In the light of these results, doctors say it is important for patients to enter any clear and armed weight loss surgery with information.
"What I try to explain to everyone is that a band is a diet with a seat belt, there is no metabolic weight loss component at all," says Mitchell Roslin, MD, chief of bariatric surgery at the North Hospital Westchester, Mount Kisco, NY "You put a seat belt around the stomach."
Often significant weight loss, by itself, will improve diabetes.
As far as people lose weight with the band back, Roslin says, they can see diabetes improve. But weight loss with the band back tends to be slower than with a bypass and long term may not be so substantial.
If control of diabetes is a primordial concern, having an operation that contorts the upper intestine is probably the best bet, says John G. Kral, MD, director of surgical services at Suny Downstate Medical Center in New York.
"Adding type 2 diabetes to equation, evidence is clear that diversionary operations are more effective. This is a powerful factor for a patient who would come by requesting a bariatric operation and having type 2 diabetes," says Kral.
However, he adds that gastric deviation is a complicated procedure that is best performed by an experienced surgeon in a hospital where they are frequently performed.Kral says surgeons need to have accomplished about 125 gastric bypass procedures before they can repeatedly and repeatedly in patients.
