Gastric Banding vs. Bypass

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Last week, Governor Chris Christie of New Jersey revealed to the public that he underwent bariatric (weight-loss) surgery earlier this year. Rather than opting for the more popular gastric bypass procedure, Christie went for gastric banding. Originally approved by the US Food and Drug Administration (FDA) in 2001, gastric banding involves constricting the top of the stomach with an adjustable band, creating a small pouch that heavily restricts food intake. In 2011, the FDA approved the procedure for adults with a body-mass index less than 40, the previously approved threshold for the surgery.

Gastric banding is often touted as the least invasive, least complication-prone form of bariatric surgery. Dr. Richard Besser, chief health and medical correspondent for ABC News, essentially affirmed this view in an article published the day of Christie’s announcement. Yet there is evidence that gastric banding is less effective than gastric bypass, both at inducing weight loss and at resolving Type 2 diabetes — an outcome that occurs in as many as 85% of people with diabetes who undergo gastric bypass. A graphic comparison of gastric banding with gastric bypass (along with a third procedure, sleeve gastrectomy), including illustrations that show what each surgery entails and a chart of details and outcomes of each surgery, is offered by Realize, the maker of adjustable gastric bands. This comparison shows that while gastric banding is less invasive and surgically complicated, it results in only a 47.8% rate of diabetes resolution (versus 83.7%), a 43% reduction in excess body weight (versus 61.6%), and a 78.3% rate of high cholesterol resolution (versus 94.9%).

In addition to concerns about its efficacy, gastric banding has received criticism for not being as complication-free as it often initially seems. As David Spero writes in a blog post from two years ago, gastric bands can slip, erode, or become infected over time, creating the need for another surgery to remove or replace them. One study found that the failure rate of gastric bands was 13.2% at 18 months after surgery, 23.8% at 3 years after surgery, and 36.9% at 7 years after surgery. Another study, published last year in the journal Archives of Surgery (now called JAMA Surgery), found that gastric banding had a lower early complication rate than gastric bypass (5.4% versus 17.2%), with a similar rate of major complications. After six years, however, gastric banding had a much higher rate of failure, with failure defined as a body-mass index above 35 or removal of the gastric band (48.3% for banding versus 12.3% for bypass). Over six years, gastric banding also had a higher rate of complications (41.6% versus 19%) and reoperations (26.7% versus 12.7%).

What do you think — despite its potential disadvantages, does gastric banding appeal to you? If so, is this primarily because it is reversible, unlike gastric bypass, or for another reason? Have you undergone gastric banding or gastric bypass, and if so, what were your experiences? Do the benefits outweigh the inconveniences and side effects? Leave a comment below!

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