Stomach bypass operation best for extreme obesity

[Elisabethsew 50]

Here's a recent study that I found:

Jul 18 (Reuters Health) - Although technically more challenging, laparoscopic Roux-en-Y gastric bypass, a common type of stomach bypass operation, provides greater weight loss in severely obese patients than does placing a plastic band around the stomach to make it smaller, new research shows. Stomach bypass is also more likely than banding to promote the resolution of diseases often seen in obese patients, such as high blood pressure and diabetes.

Although multiple trials have compared the two procedures, this is the first study to focus specifically on patients with a BMI greater than 50 -- with super morbid obesity -- Dr. George Ferzli and his associates report in their article, published in the Archives of Surgery. BMI is a measure of body weight for height. Values between 20 and 25 are typically considered normal. Any value of 30 or greater is considered obese.

This information is vital for patients considering weight loss surgery, Ferzli told Reuters Health, "because proper patient and procedure selection, proper follow-up, and proper long-term support are quite important in achieving the desired outcome."

At the SUNY-Health Science Center of Brooklyn in Staten Island, New York, patients undergoing weight loss surgery decided which procedure would be performed, after receiving extensive counseling. To be eligible, the patients had to complete a supervised dietary and exercise program of 8 to 12 months without maintaining weight loss.

Ferzli performed more than 315 weight loss procedures between February 2001 and June 2004. Among 106 super morbidly obese patients, 60 underwent stomach banding and 46 underwent stomach bypass.

Stomach bypass took longer perform in the OR than did stomach banding. Moreover, patients treated with stomach bypass were hospitalized for a day or two longer. There were no differences between the operations in the rate of early complications.

After 30 days, however, patients treated with stomach bypass had fewer complications than those treated with banding and also lost more weight.

"We believe that the band requires significant will and discipline and compliance, otherwise the patient can get things by the restricted area, especially high-calorie liquids," Ferzli noted. Complications are likely to result from patients "not eating properly, trying to force things down by eat rapidly or not chewing properly."

"In our experience, laparoscopic Roux-en-Y gastric bypass appears superior to laparoscopic adjustable gastric banding in super morbidly obese patients," Ferzli and his associates conclude in their paper.

There is a subset of severely obese patients for whom gastric band would be more appropriate, Ferzli added. "We now reserve gastric banding to patients who cannot have gastric bypass surgery, because of such conditions as liver disease or (stomach disease) and ulceration that require frequent endoscopy."

SOURCE: Archives of Surgery, July 2006.

[Chickie 15]

"We believe that the band requires significant will and discipline and compliance, otherwise the patient can get things by the restricted area, especially high-calorie liquids, " Ferzli noted. Complications are likely to result from patients "not eating properly, trying to force things down by eat rapidly or not chewing properly."

You know, I think they might be right.

[Wheetsin 714]

So what they're really saying is "morbidly obese people don't have the discipline to avoid milkshakes." :biggrin1:

My thoughts for the day...

I've wondered a few times where I would be at now if I'd had the RNY. Not out of regret or longing, but just pure curiosity. And then I think of all the things I'm getting from my band that go beyond the weightloss itself. A lot of it is highlighted in that article, and deals mainly with the idea that beyond restricting my portions, my band is helping me learn to eat better. Maybe "making me eat better" is more accurate, but... whatever. When I can only eat X ounces of food per day, and I'm trying to keep my weightloss going, my skin clear, my hair from falling out, my body hydrated, my plumbing unclogged, etc. -- the junk food just isn't worth it, because every bite of crap I take is a bite of something else I can't take... and I need that "something else" to try and keep things going smoothly. And perhaps most importantly, for the first time in the MANY years that I've been overweight, I'm starting to let myself believe I may actually, finally get there this time.

Just the other day I had lunch with a friend who had bypass about 3 years ago. She lost 130 lbs in under a year, and hasn't been able to take any more off since. She's not looking great. Her color is off, her hair is noticeably thinned, her energy isn't great. In her own words, "I'm just now beginning to really see the long term effects of this surgery." Maybe she's having a particularly bad time, I don't know -- I picked the other surgery -- but I know that she also told me she wished she'd have researched the band before having her operation. Her surgery too has taught her different eating habits, because she either gets dreadfully ill if she eats the wrong thing, or risks going (essentially) back to her same pre-op state if she eats too much.

I know that as someone who had a BMI over 50, if bypass were the only option I had, I'd still haver a BMI over 50.

So cheers to all of us super BMIers, or not so super BMIers, who are determined to beat the band statistics!

[lisah25 3]

After 30 days, however, patients treated with stomach bypass had fewer complications than those treated with banding and also lost more weight.

"We believe that the band requires significant will and discipline and compliance, otherwise the patient can get things by the restricted area, especially high-calorie liquids," Ferzli noted. Complications are likely to result from patients "not eating properly, trying to force things down by eat rapidly or not chewing properly."

I saw the same report.

I'd be very interested in know about complications and all more then 30 days out.

[sbmorgaine 0]

From a lot of the stuff I have read, they include things like PBing and such as complications. they are considered "mild" complications, but they include them in the statistics.

[Elisabethsew 50]

Since I'm in the medical profession and work in the same health care system that I had my surgery in, I often spend some chatting with the PA's in my surgeon's office. They said that the biggest problem they encounter with patients is that "more than you think are not truthful with us."

It seems they have a lot of patients who WANT to be overfilled in an effort to lose the weight faster. Despite lectures that they can damage their esophagus, GAIN weight by DRINKING their calories, etc., quite a few of the patients simply don't care and refuse to have an unfill. Obviously, the staff documents this noncompliance with medical advice but they can't tie a patient down and force them to have an unfill.

When I read the article I posted, I wondered if these people are the very ones who contribute to the complication statistics. Hmmmmmmmmmmm...

[FunnyDuddies 6]

the reason I think the whole article is BS is that they claim that something is better for one group of people, yet they do not look at the overall long term effects.

Yes - bypass patients lose more in the first year than most band patients

Yes - bypass patients don't have to think or work on the losing like band patients

Yes - bypass is probably good for someone who is so obese that they are close to death because of the quickness and ease of losing weight

but what about past the 30 days out? What about after the first year? When bypass patients begin losing teeth, and hair, and color, and their eyesight? What about the years that are taken off the end of their life due to malnutrition and permanant damage done to the body? What about the alarming rate at which bypass patients gain their weight back because they are never taught how to properly eat, and their no-brainer surgery basically reverses itself after 3 years?

There was no other choice for me but the band. And I am going to work the band to lose the weight as fast as I can, so that in the small chance that I lose it for some reason, I will be close to or at goal with new eating habits and will not have to try any other form of wls.

[Elisabethsew 50]

I think it's good that more research is being done on ALL weight loss surgery and offered the professional article as an FYI purpose.

My surgeon explained to me that just a few years ago, many MDs would not perform lapbanding on obese patients who were empty carbohydrate eaters. Now, that has changed and surgeons offer options in WLS based on eating patterns. Of course, the final decision rests with the patient.

Hopefully, more studies will be done evaluating long term surgery results of the various WLS options currently available.

[Wheetsin 714]

I've been reading on this (for the last 6ish months, not that long) to see how the weightloss averages are obtained. On average, RNY patients lose more weight, lose it more quickly, etc. Even though I haven't seen this statistic formally compared, if you extrapolate the numbers and do the math, the average RNY patient is something like 42% fatter than the average LB patient.

It stands to reason that if you take a patient who's fatter and compare their 6 month, 8 month, 12 months, (whatever) loss, it would stand to reason that the fatter person loses a greater amount of weight in less time.

Granted this doesn't address percentages of weight to lose, but we don't have as much time with the studies either.

Many surgeons quote an RNY average loss of "10 lbs per month".

I'm averaging right around 19 - 20 lbs per month. Yes, that will slow down, but I'm close to the 6 month mark that the "10 lbs per month" was quoted at. I know several other LBers who are averaging 10+ per month.

I'm a numbers kind of girl. I enjoy doing the analysis. But on the most fundamental level what it boils down to is -- who cares?

[FunnyDuddies 6]

what it boils down to is -- who cares?

AMEN! LOL really I think we just need to be happy with the choice that we have made. I did research for years on the wls out there, and finally decided on the lapband. I did more research on it for another year after making that decision, because i wanted to make sure i knew everything about it before having it done, and I wanted to pick the right doctor. I know that there are people who go into a doc, or see an ad on tv, and are scheduled the newxt week for surgery and they still don't know if it is the best thing for them. I think that is a dangerous approach. You jsut have to feel comfortable with the choice that you have made. No one knows your body better than you, and that should be who makes the decision for you.

[princess_n_thep 2]

After time, bypass patients can tolerate more and more sugar (my mom and sister had it 6 or so years ago). They both live more normal eating now that their bodies have adjusted to the surgery. I think they are very similar though in terms of what works. It just takes longer for the band to lose the weight and it takes longer for the bypass to adjust to the foods. The only difference in my mind is that one is lifelong and the other is longterm.

[Nykee 13]

My surgeon explained to me that just a few years ago, many MDs would not perform lapbanding on obese patients who were empty carbohydrate eaters.

>>>> I agree with that.

If LIKE me, I have always drank my calories and snacked all day long..

(A gallon of milk and juice a day or MORE....no joke)

I am someone who does not think that GB is better than the Band

BUT that the GB is what I needed in order to help me personally

Its MY best choice...

But I didnt realize that.. and now I have a band that doesnt 'work' for me.

[xelapaul 0]

So what they're really saying is "morbidly obese people don't have the discipline to avoid milkshakes." :biggrin1:

My thoughts for the day...

I've wondered a few times where I would be at now if I'd had the RNY. Not out of regret or longing, but just pure curiosity. And then I think of all the things I'm getting from my band that go beyond the weightloss itself. A lot of it is highlighted in that article, and deals mainly with the idea that beyond restricting my portions, my band is helping me learn to eat better. Maybe "making me eat better" is more accurate, but... whatever. When I can only eat X ounces of food per day, and I'm trying to keep my weightloss going, my skin clear, my hair from falling out, my body hydrated, my plumbing unclogged, etc. -- the junk food just isn't worth it, because every bite of crap I take is a bite of something else I can't take... and I need that "something else" to try and keep things going smoothly. And perhaps most importantly, for the first time in the MANY years that I've been overweight, I'm starting to let myself believe I may actually, finally get there this time.

Just the other day I had lunch with a friend who had bypass about 3 years ago. She lost 130 lbs in under a year, and hasn't been able to take any more off since. She's not looking great. Her color is off, her hair is noticeably thinned, her energy isn't great. In her own words, "I'm just now beginning to really see the long term effects of this surgery." Maybe she's having a particularly bad time, I don't know -- I picked the other surgery -- but I know that she also told me she wished she'd have researched the band before having her operation. Her surgery too has taught her different eating habits, because she either gets dreadfully ill if she eats the wrong thing, or risks going (essentially) back to her same pre-op state if she eats too much.

I know that as someone who had a BMI over 50, if bypass were the only option I had, I'd still haver a BMI over 50.

So cheers to all of us super BMIers, or not so super BMIers, who are determined to beat the band statistics!

:tea:

Bravo!

You have very elequently pointed out what many in the industry fail to do to their perspective patients.

[Nykee 13]

So what they're really saying is "morbidly obese people don't have the discipline to avoid milkshakes." :biggrin1:

>>>>>>>>>>>>>some dont.

or havent for 20 plus years..

[Wheetsin 714]

Undoubtedly. Kindof my point. Either surgery takes a change of mental perspective to succeed. You can out eat either solution, if that's what you're determined to do. I know bandsters who now weigh more than their surgery day, and I know RNY patients who weigh more. They weren't willing to do their part -- ultimately, even after all they had gone through, it wasn't worth it to them.