Secondo gli studi pubblicati dalla rivista medica JAMA e condotti dall’ Università del Texas, nota anche come UT Southwestern, uno dei più importanti Centri medici accademici al Mondo, hanno evidenziato che i pazienti che si sono sottoposti ad intervento chirurgico di bypass gastrico hanno perso circa il 66% del loro peso in eccesso, rispetto al 45% di quelli sottoposti alla procedura di bendaggio gastrico, ottenendo così una maggiore perdita di peso a lungo termine, un maggiore controllo del diabete di tipo 2 e della pressione alta nonché un significativo abbassamento dei livelli di colesterolo nel sangue.
Gastric bypass surgery has better outcomes than gastric banding for long-term weight loss, controlling type 2 diabetes and high blood pressure, and lowering cholesterol levels, according to a review by UT Southwestern Medical Center surgeons of nearly 30 long-term studies comparing the two types of bariatric procedures.
The review, published in JAMA, found that those undergoing gastric bypass operations lost more weight – an average of 66 percent of their excess weight – compared to 45 percent average excess weight loss for those undergoing gastric banding procedures.
“We know gastric bypass brings more weight loss success and relief of commonly associated illness versus gastric band at one year after surgery,” said Dr Nancy Puzziferri, Assistant Professor of Surgery and part of the bariatric surgery team at UT Southwestern. “We now have the best evidence available telling us this outcome continues to be true even up to five years after surgery. We also know these procedures maintain their safety profile long-term.”
The researchers also reported dramatic differences between the two procedures in controlling diabetes; more than two-thirds of gastric bypass patients with T2DM saw remission of the disease, compared to less than a third of gastric band patients.
Gastric bypass surgery also lowered hypertension better than gastric banding. Nearly half of patients (48 percent) with hypertension reported remission after two years with gastric bypass, compared to less than a fifth (17 percent) for those undergoing gastric band procedures.
Gastric bypass also improved hyperlipidemia, with approximately 60 percent of gastric bypass patients reported remission in the studies, compared to about 23 percent of gastric band patients.
“The review underscores the importance of thinking about durable treatments, as obesity, type 2 diabetes, hypertension, and elevated cholesterol are chronic illnesses, rather than focusing on short-term results,” said Puzziferri.
Long-term complication rates for the two procedures also favoured gastric bypass, through both were relatively low, less than 3 percent for bypass surgery and less than 5 percent for banding procedures.
They also concluded there were not a sufficient number of studies meeting these criteria to accurately assess gastric sleeve procedures.
“It is also very important to understand sleeve gastrectomy, which with the evidence we have so far, appears to perform as well as gastric bypass for weight loss. We just don’t have as much evidence, in quantity or quality, as we have for the other procedures. The evidence will come in time,” she added. “We have not been doing sleeve gastrectomies for as many years as we have been performing gastric bypass or gastric band surgeries.”
They carried out the study to assess the quality of evidence and treatment effectiveness two years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults.
The review focused only on studies that followed patients for at least two years and in which more than 80 percent of patients were successfully tracked during that time; 29 studies total. Most (97 percent) of weight-loss surgery studies track only a small percent of patients and/or only for up to one year. The researchers suggested more studies are needed to look at long-term outcomes, at least two years past the initial surgery, while maintaining follow-up of at least 80 percent to be considered reliable.
“Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results,” they concluded. “Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.”
Owen Haskins – Editor in chief, Bariatric News
Long-term follow-up after bariatric surgery: a systematic review.
JAMA, 2014.JAMA. 2014 312(9):934-42.
Citation data from PubMed