Should I have a gastric band or a sleeve gastrectomy?
There are a lot of factors that come into deciding which weight loss operation is best for a patient: their health, their understanding, family members who have had an operation (or an opinion), and so on. The most important factor, however, may be the end goal. Why does a person want or need this operation. For most bariatric surgeons, it is all about the health. Choosing the operation that is most likely to cure their obesity and related comorbid conditions (e.g. diabetes and hypertension) is very important. The resolution of disease (not necessarily the pounds lost) is what is most important.So what about a band versus a sleeve or gastric bypass?
Adjustable gastric banding, gastric bypass, and sleeve gastrectomy are the most commonly performed weight loss operations in the United States. The amount of weight patients will lose over time is a vital aspect of deciding which procedure they will choose.
At the University of Texas in Houston, we have collected follow up data on 3430 band patients, 3155 bypasses patients, and 108 sleeve gastrectomy patients and compared the weight loss over time for these procedures using and analysis of variance (ANOVA). We also used the best fit curves to interpolate the expected time to cure of obesity after banding and bypass.
Gastric bypass and sleeve gastrectomy had similar weight loss over time (0.41 and 0.37 %EWL/day out from surgery, respectively, p =0.34), and both of them were significantly higher than banding (0.33 %EWL/day out from surgery, p<0.001). Patients with higher starting BMIs were cured of obesity faster with bypass than bands, but after three years had a similar time to cure for same BMIs.
So, it seems, that sleeve gastrectomy offers the same rate of weight loss as the gastric bypass at 1.4 years and is significantly better than the rate of weight loss observed with gastric banding, suggesting hormonal weight loss factors at play. Higher BMIs are initially cured more readily with bypass than bands; however, the starting BMI cure rate is the same regardless of procedure performed after two years.Therefore, if you have a higher BMI (>45), banding is less desirable than gastric bypass or sleeve gastrectomy.
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