Gastrointestinal Complications of Obesity Surgery

John E. Pandolfino, MD; Brintha Krishnamoorthy, BS; Thomas J. Lee, MD

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In This Article

Comparison of the Procedures

Comparison studies have been performed to evaluate the various bariatric procedures. In general, RYGBP has been found to be the superior approach. One study[28] compared laparoscopic RYGBP and laparoscopic adjustable gastric banding; at 18 months post operation, patients who had RYGBP had an excess weight loss of 74.6% vs 40.4% excess weight loss after gastric banding. This difference was also maintained at 2-, 3-, and 4-year follow-up intervals,[28,29] demonstrating that gastric bypass was superior to the laparoscopic adjustable banding system. In addition, a study from Sweden[30] reported that within 7 years of their operation, 58% of 90 patients who underwent laparoscopic adjustable gastric banding were converted to RYGBP because of multiple complications (esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation).

Randomized trials comparing gastric bypass against VBG have reported greater weight loss in patients who underwent gastric bypass surgery.[12,16,31] In one trial,[12] average weight loss at postoperative year 1 was reported to be 42% after VBG and 68% after gastric bypass. At the 3-year, follow-up period, these differences in weight loss remained significant. In addition, long-term evaluations confirmed that weight loss was maintained for up to 14 years after gastric bypass surgery,[24] whereas patients who underwent VBG had poor sustained weight loss at 10 or more years post procedure.[13]

BPD procedures have had success in achieving excess weight loss greater than 75%,[2,32] slightly more than that reported with traditional gastric bypass operations. In a retrospective comparison[27] of 138 patients who underwent RYGBP and 105 patients who underwent distal gastric bypass/duodenal switch, similar excess weight loss was reported -- with excess weight-loss rates at 2 years post operation of 74% and 78%, respectively. These results coupled with the possibility of lower rates of protein deficiency and anastomotic complications make distal gastric bypass/duodenal switch an attractive surgical option. However, more long-term data are required before it is universally accepted.

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