Which Weight-Loss Surgery Is Best?

Posted on November 9, 2018

By Serena Gordon, HealthDay Reporter

TUESDAY, Oct. 30, 2018 (HealthDay News) -- Deciding to have weight-loss surgery is tough enough, but then you have to choose between several procedures -- each with different risks and potential weight loss.

So how do you decide which one is best for you?

New research that compares three types of weight-loss surgery in more than 46,000 patients may help. The three types of surgery included gastric bypass, sleeve gastrectomy and adjustable gastric banding (also known as lap band).

The study found that gastric bypass surgery boasted the greatest weight loss -- both short- and long-term. But that procedure also had the highest rates of complications in the month following surgery.

"There are trade-offs. Bypass is more effective for weight loss, but has a greater risk of short-term complications. People need to consider, 'What do I value most?' Is safety your biggest concern? Or, is it the magnitude of the weight loss?" said study lead author Dr. David Arterburn. He's a senior researcher at the Kaiser Permanente Washington Health Research Institute in Seattle.

Arterburn added that it's important to consider other weight-loss treatments, such as medication.

Nearly 25,000 people in the study had Roux-en-Y gastric bypass. This procedure involves making the stomach smaller and bypassing part of the small intestine, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). After this surgery, people get fuller on much less food, and the body doesn't absorb as many calories.

Almost 19,000 people in the study had sleeve gastrectomy, which involves taking out a portion of your stomach so that you get fuller faster.

Finally, more than 2,500 people had adjustable lap-band surgery. A surgeon places an inflatable band around the top of your stomach, leaving only a small pouch that can be filled with food. The rest of your stomach is filled with a balloon containing saline solution that is attached to the band, according to NIDDK. Arterburn said this procedure has fallen out of favor in recent years.

The study found that gastric bypass appeared to be most effective for weight loss:

Gastric bypass surgery resulted in an average 31 percent loss of total body weight in the first year and 25 percent of total body weight after five years.
Sleeve gastrectomy led to a 25 percent loss in total body weight in the first year and 19 percent loss of total body weight after five years.
Adjustable gastric banding led to a 14 percent total weight loss after a year and 12 percent at five years.

For the average person in this study, there was a 19-pound weight loss difference between the bypass and sleeve procedures after five years. The average person in this study weighed 277 pounds before surgery, the researchers said.

But the 30-day rate of serious complications for gastric bypass was nearly double the risk of the sleeve procedure. The rate of complications in the 30-day period after surgery was 5 percent for gastric bypass, 2.6 percent for sleeve gastrectomy and 2.9 percent for adjustable gastric banding.

The complications measured in the study included death, reoperation/repair procedures, clots, or failure to be discharged from the hospital within 30 days.

Gastric bypass and sleeve gastrectomy are similar in terms of cost, according to Arterburn. Each procedure averages between $20,000 and $30,000, he estimated. Adjustable gastric banding is less expensive and may average around $15,000, he noted. Insurance coverage for these procedures varies quite a bit, and not all will cover weight-loss surgery.

Dr. Mitchell Roslin, director of the bariatric surgery program at Northern Westchester Hospital in Mount Kisco, N.Y., said that people shouldn't only focus on the total weight loss when trying to select a procedure.

"There is no perfect way. The more we change the body, the higher the weight loss, but complications may be higher. There's no one-size-fits-all weight-loss surgery," said Roslin, who wasn't involved with the study.

"The decision really requires detailed conversation and education. You need to understand your own individual medical issues and objectives," he said.

Arterburn added that people should look for a surgeon that has experience in multiple weight-loss procedures.

"Not every surgeon is equally comfortable with all of the procedures. Have a conversation with a surgeon who does all of the surgeries so the conversation is about what's right for you," he said.

SOURCES: David Arterburn, M.D., senior researcher, Kaiser Permanente Washington Health Research Institute, Seattle; Mitchell Roslin, M.D., director, bariatric surgery program, Northern Westchester Hospital, Mount Kisco, N.Y.; Oct. 29, 2018, Annals of Internal Medicine

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