With different procedures available, and some centers favoring one over the other, how does one learn which kind of weight loss surgery is most effective? We will look at some comparative studies, but it is important to keep in mind that the wisest approach is to balance both “effectiveness,” which usually defined as pounds lost and health restored, with safety and side effects.
Weight Loss Surgery Data
In the Swedish Obese Subjects study over 20 years, gastric bypass was a good deal more effective than gastric banding.
A more recent comparison study found gastric bypass (RYGB) was moderately more effective than sleeve (SG), and a lot more effective than gastric banding (AGB) over a five-year time frame:
However, the randomized trial known as the SLEEVEPASS trial showed gastric bypass and sleeve results were statistically equivalent, but gastric bypass had twice as many complications:
I would also add that Duodenal Switch, the procedure most people have heard the last about, has always been the most effective though the most complex procedure. In the following study, Duodenal Switch (sometimes referred as its closely related procedure called Biliopancreatic Diversion) resulted in not only the most weight loss, but was quite a bit more successful in treating and reversing major health conditions like type 2 diabetes and high blood pressure. (Also, of note, in this study, sleeve was more effective than gastric bypass.)
So, where does that leave us?
Making Sense of Your Options
Here are a few useful considerations if you are weighing which weight loss procedure is most effective:
- Beware of centers and surgeons who only do one procedure. While it might mean they are good at that procedure, it means there is less understanding of the overall procedures, and, importantly, there is less individualization to tailor the procedure to the specific person and their health.
- The most widely performed procedure today is the laparoscopic sleeve gastrectomy, for good reason. It is very effective, close to that of gastric bypass. But it is also the simplest, safest procedure with the fewest side effects or complications. And it is the easiest to modify later if it did not work.
- Most experts believe the most effective procedure is the Duodenal Switch, but few centers and surgeons are skilled at performing it. Complications are somewhat higher. Some centers, like our own, offer this procedure as a highly effective revision procedure.
- Gastric bypass remains an effective option, and it might be the best choice for a person with severe gastroesophageal reflux (GERD) or Barrett’s esophagus.
- There is little reason to choose a gastric band today. In rare cases it may make sense, but mostly it is demonstrably less effective and has too many long-term adverse effects related to the device, ten to fifteen years later.
- Always to talk to an experienced, respected bariatric surgeon who can skillfully perform all of the procedures laparoscopically and who can individualize the choice, look you in the eye and advise what he would do if you were his sibling or parent.
If you’re considering weight loss surgery, the team at Sasse Surgical has the experience and education to answer all of your questions about your options and make recommendations for the safest, most effective procedure based on your circumstances. Contact us today to schedule a telemedicine appointment.