There are a large number of choices available today when it comes to weight loss surgery, from the classical Roux-en-Y gastric bypass to laparoscopic or robotic adjustable gastric banding, but which is the best choice for patients with a particularly high BMI?
First we need to define what we mean by a particularly high BMI. It is generally accepted that obesity starts at a BMI of 30 and becomes morbid obesity at 40. This is the point at which most doctors will consider a surgical solution to the problem. With a BMI in the 40s patients are generally suitable for all forms of weight loss surgery (unless excluded by such things as co-existing medical condition) however, as BMI passes 50, the risks of gastric bypass surgery rise steeply and choices become limited. Against this background we would define a particularly high BMI as being 50 or above.
Despite the increased risks, some patients are nonetheless considered suitable and do opt for gastric bypass surgery while others take the safer route of gastric banding, but which is better?
In a recent study involving 106 patients (all of whom had a BMI in excess of 50) 60 patients underwent gastric banding while the remaining 46 opted for gastric bypass surgery. More than three quarters of the gastric banding patients suffered complications, which included dehydration and vomiting, while less than one third of the gastric bypass patients suffered complications. In addition, the gastric banding patients experienced only about one third of the weight loss recorded for the gastric bypass patients.
Perhaps most surprisingly, more than three quarters of the gastric bypass patients were satisfied with their result and none regretted their choice. By contrast, less than half of the gastric banding patients were happy with the results and ten percent actually expressed dissatisfaction or regretted their decision.
On the surface therefore it would appear that gastric bypass surgery is clearly the preferred choice. However, for many patients with a high BMI this is simply not an option as the risks are simply too high, so what is the answer in these cases?
Without doubt the preferred option is a combination of restrictive surgery, such as gastric banding, in the first instance to reduce weight to less than a BMI of 50 and then to follow this up with a second form of absorption surgery, such as the gastric bypass. In many cases however, rather than gastric banding, the preferred choice is to use a vertical gastrectomy (sometimes referred to as a vertical sleeve gastrectomy) as the first element in this two-stage surgical process.
