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Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison.
Obes Surg. 2004 May; 14(5):626-34.OS

Abstract

BACKGROUND

Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional open approach.

METHODS

From December 2000 to February 2002, 80 patients (24 men and 56 women; mean age 32 years, range 18-57) with morbid obesity (mean BMI 43.2 kg/m(2), range 36-59.8) were enrolled in a prospective trial and randomly assigned to LVBG or LGBP. Changes in quality of life were assessed using the Gastro-intestinal quality of life index (GIQLI).

RESULTS

The conversion rate was zero for LVBG and 2.5% (1/40) for LGBP. There has been no mortality. Surgical time was significantly longer for LGBP (209 minvs 126 min for LVBG, P<0.001). Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP (P<0.001). Postoperative analgesic usage was also less for LVBG patients (mean dose 1.4 vs 2.4, P<0.05). Early complication rate was higher in the LGBP group (17.8% vs 2.5%, P<0.001). All 3 major complications were in the LGBP group, of which 2 were related to anastomotic leakage (5%). Late complications consisted of upper GI bleeding, stenosis and others observed in 4 LGBP patients (10%) and 2 LVBG patients (5%). Mean follow-up was 20 months (range 18 to 30). BMI fell significantly in both groups, with significant improvement of obesity-related co-morbidities. LGBP had significantly better excess weight loss than LVBG (62.9% vs 55.4% at 1 year and 71.4% vs 53.1% at 2 years), as well as lower BMI than LVBG (29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years). There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP (11.8 vs 13.8, P<0.05). Preoperative GIQLI scores were similar between the groups; however, at 1 year, LGBP patients had better GIOLI scores than LVBG patients (121 vs 106, P<0.01). LVBG had improvement in physical condition, social function and emotional conditioning but deterioration in GI symptoms which resulted in no increase in total GIQLI score.

CONCLUSION

LGBP was a time-consuming demanding technique with a higher early complication rate compared with LVBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient's decision.

Authors+Show Affiliations

Department of Surgery, En-Chu Kong Hospital, Taiwan. wjlee@km.eck.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15186629

Citation

Lee, Wei-Jei, et al. "Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison." Obesity Surgery, vol. 14, no. 5, 2004, pp. 626-34.
Lee WJ, Huang MT, Yu PJ, et al. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004;14(5):626-34.
Lee, W. J., Huang, M. T., Yu, P. J., Wang, W., & Chen, T. C. (2004). Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obesity Surgery, 14(5), 626-34.
Lee WJ, et al. Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison. Obes Surg. 2004;14(5):626-34. PubMed PMID: 15186629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. AU - Lee,Wei-Jei, AU - Huang,Ming-Te, AU - Yu,Po-Jui, AU - Wang,Weu, AU - Chen,Tai-Chi, PY - 2004/6/10/pubmed PY - 2004/9/8/medline PY - 2004/6/10/entrez SP - 626 EP - 34 JF - Obesity surgery JO - Obes Surg VL - 14 IS - 5 N2 - BACKGROUND: Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional open approach. METHODS: From December 2000 to February 2002, 80 patients (24 men and 56 women; mean age 32 years, range 18-57) with morbid obesity (mean BMI 43.2 kg/m(2), range 36-59.8) were enrolled in a prospective trial and randomly assigned to LVBG or LGBP. Changes in quality of life were assessed using the Gastro-intestinal quality of life index (GIQLI). RESULTS: The conversion rate was zero for LVBG and 2.5% (1/40) for LGBP. There has been no mortality. Surgical time was significantly longer for LGBP (209 minvs 126 min for LVBG, P<0.001). Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP (P<0.001). Postoperative analgesic usage was also less for LVBG patients (mean dose 1.4 vs 2.4, P<0.05). Early complication rate was higher in the LGBP group (17.8% vs 2.5%, P<0.001). All 3 major complications were in the LGBP group, of which 2 were related to anastomotic leakage (5%). Late complications consisted of upper GI bleeding, stenosis and others observed in 4 LGBP patients (10%) and 2 LVBG patients (5%). Mean follow-up was 20 months (range 18 to 30). BMI fell significantly in both groups, with significant improvement of obesity-related co-morbidities. LGBP had significantly better excess weight loss than LVBG (62.9% vs 55.4% at 1 year and 71.4% vs 53.1% at 2 years), as well as lower BMI than LVBG (29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years). There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP (11.8 vs 13.8, P<0.05). Preoperative GIQLI scores were similar between the groups; however, at 1 year, LGBP patients had better GIOLI scores than LVBG patients (121 vs 106, P<0.01). LVBG had improvement in physical condition, social function and emotional conditioning but deterioration in GI symptoms which resulted in no increase in total GIQLI score. CONCLUSION: LGBP was a time-consuming demanding technique with a higher early complication rate compared with LVBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient's decision. SN - 0960-8923 UR - https://www.unboundmedicine.com/medline/citation/15186629/Laparoscopic_vertical_banded_gastroplasty_and_laparoscopic_gastric_bypass:_a_comparison_ L2 - https://dx.doi.org/10.1381/096089204323093390 DB - PRIME DP - Unbound Medicine ER -