Patient Factors Associated with Undergoing Laparoscopic Adjustable Gastric Banding vs Roux-en-Y Gastric Bypass for Weight Loss

Abstract

Background Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are two commonly performed bariatric procedures in the US with different profiles for risk and effectiveness. Little is known about factors that might lead patients to proceed with one procedure over the other. Study Design We recruited and interviewed patients seeking bariatric surgery from 2 academic centers in Boston (response rate 70%). We conducted multivariable analyses to identify patient perceptions and clinical and behavioral characteristics that correlated with undergoing gastric banding (n=237) versus gastric bypass (n=298). Results After adjustment for sociodemographic and clinical factors, we found that older patients [OR 1.03 (95 % CI1.00-1.05)] and those with higher quality of life (QOL) scores and higher levels of uncontrolled eating were more likely to undergo gastric banding as opposed to gastric bypass. In contrast, patients with type 2 diabetes [0.46 (0.28,0.77)those who desired greater weight loss, and those who were willing to assume higher mortality risk to achieve their ideal weight were less likely to proceed with gastric banding. After initial adjustment, male sex and lower BMI were associated with likelihood to undergo gastric banding; however, these factors were no longer significant after adjustment for other significant correlates such as patients' perceived ideal weight, predilection to assume risk to lose weight, and eating behavior. Conclusions Patients' diabetes status, quality of life, eating behavior, ideal weight loss, and willingness to assume mortality risk to lose weight were associated with whether patients proceeded with gastric banding as opposed to gastric bypass. Other clinical factors were less important.

Can Classical Roux-N-Y Gastric Bypass Be Combined with Surgical Emergencies? An Interesting Case Series with Literature Review of Two Patients at a Tertiary Care Center

“…1 7 8 However, one has to consider the clinical profile of patients, their choice and fitness, surgeon experience 9 and comfort level, the availability of equipment and assistants, possibility of follow-up, compliance of the patient to dietary restrictions and abstinence from addictions, need or possibility of reversal or revision, and the financial status of the paying patient, while deciding on the ideal procedure for that patient in any particular situation. 10 The best postoperative control of comorbidities has arguably been achieved with the Roux-N-Y gastric bypass, irrespective of the technique, 11 12 13 and this leads to many patients choosing this procedure after counseling, and us in promoting this procedure as a definitive, though irreversible, procedure for loss of excess body fat as well as control of comorbid status. Having said that, one must remember that literature is evolving continually, and new evidence points that there may not be much to choose between the two procedures 14 after all.…”

A comparative study of eating behaviours within and between conventional metabolic (bariatric) surgery procedures

“…Uncontrolled eating, a construct from the modified version of the TFEQ, is a factor formulated from disinhibition and hunger items (Karlsson et al, 2000). Apovian et al (2013) postulated that this may have been due to patients' preference for an adjustable band with adjustable control rather than an irreversible non-adjustable procedure. It is also noted in this study that those in the band group weighed significantly less than the bypass and sleeve groups pre-surgery.…”