A paired study published Jan. 16 in the online edition of the journal Archives of Surgery shows that gastrojejunostomy (Roux-en-Y) gastric bypass is associated with greater, faster and more durable weight loss than gastric banding, but with more frequent complications. Principal investigator Dr. Sébastein Romy of the Department of Vascular Surgery at the University Centre Hospital Vaudois in Lausanne, Switzerland, believes that the weight loss benefits of gastrojejunostomy make it more useful in correcting concomitant diseases of obesity, such as dyslipidemia and high fasting glucose levels (Arch. Surg. 2012 Jan. 16 [doi: 10. 1001/archsurg. 2011. 1708]). 1708]). The number of bariatric surgery cases performed in the United States has increased rapidly in recent years, with gastric banding increasing most significantly. “This may be due to the fact that gastric banding is perceived as simple, safe, and reversible by both physicians and patients, and marketing campaigns by device manufacturers may also have had a large effect.” Which procedure is better has been debated, and of the 17 available studies comparing the two procedures, most had obvious methodological flaws, such as too few subjects and too short a follow-up period. Dr. Romy and colleagues performed a matched analysis of patients who underwent both procedures between 1998 and 2005. Patients enrolled were unsuccessful in weight loss with conservative treatment and all had a body mass index (BMI) ≥40 kg/m2 or a BMI ≥35 kg/m2 and at least 1 serious comorbidity. A total of 221 patients who underwent gastric bypass with gastrojejunostomy were enrolled, and 221 gastric banding patients matched for age, sex, and BMI were selected as controls. The follow-up rate remained high at 92% at 6 years after surgery in both groups. The performers performed these procedures at the same 2 hospitals. The results showed that the patients in the gastrojejunostomy group achieved maximum weight loss at an average of 18 months postoperatively, whereas the maximum weight loss in the gastric banding group occurred at an average of 36 months postoperatively. The excess weight loss rate was significantly higher in the gastrojejunostomy group than in the gastric banding group (78. 5% vs. 64. 8%), and the mean value of the lowest BMI was significantly lower than in the gastric banding group (26. 7 vs. 29. 4 kg/m2). At all time points during follow-up, the proportion of patients with an excellent or acceptable outcome was significantly higher in the gastrojejunostomy group than in the gastric banding group. Treatment failure was defined as weight loss of less than 25% of baseline weight, or the need for reversal surgery, or a change to another type of bariatric surgery. At 3 years postoperatively, no patients in the gastrojejunostomy group had treatment failure compared with 39 patients (18.2%) in the gastric banding group, and at 6 years, the rates of treatment failure were 2.5% and 38.9% for the two groups, respectively. Gastrojejunostomy also had a significantly better effect on lipid improvement. Total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride levels decreased in this group, whereas none of these indicators decreased in the gastric banding group. The patients in the gastrojejunostomy group had a more significant decrease in fasting glucose levels (89. 55 vs. 92. 79 mg/dl). Quality of life improved in both groups, but the improvement was faster and more durable after gastrojejunostomy. For example, food tolerance was unchanged in the gastrojejunostomy group, while it gradually deteriorated over time in the gastric banding group. Early complication rates were higher in the gastrojejunostomy group (17. 2% vs. 5. 4%), which the investigators believe is not unexpected because gastrojejunostomy is more complex and the procedure and hospital stay are longer. However, the vast majority of these early complications were cured with conservative treatment alone, and there was no significant difference in the rate of serious early complications between the two groups. The gastric banding group had far more long-term complications than the gastrojejunostomy group (41.6% vs. 19%) and double the proportion of patients requiring reoperation (26.7% vs. 12.7%). ”Long-term complications after gastric banding were dominated by functional problems such as esophageal dilatation (1. 4%), the need for daily high-dose proton pump inhibitor therapy due to reflux (6. 8%), severe food intolerance (6. 3%), and band erosion (7. 7%), which had to be removed in 47 patients (21. 3%). In contrast, the long-term complications after gastrojejunostomy were basically limited to anastomotic stricture, intestinal obstruction and symptomatic internal hernia. Most strictures are not serious complications and require only endoscopic dilatation for treatment. Although intestinal obstruction can be life-threatening, it does not involve the bypass or require reversal in most patients.”