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Invited Critique
February 2011February 21, 2011

Selecting the “Best” Weight Loss Procedure: More May Be BetterComment on “Better Weight Loss, Resolution of Diabetes, and Quality of Life for Laparoscopic Gastric Bypass vs Banding”

Author Affiliations

Author Affiliation: Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. Dr Sax is now with the Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California.

Arch Surg. 2011;146(2):155. doi:10.1001/archsurg.2010.317

Physicians strive to provide optimal patient care, balancing risks, benefits, and patient desires. In some cases, a more complicated, higher-risk procedure provides significantly better long-term results. Since Pories et al1 reported that open RYGB dramatically improved insulin sensitivity in morbidly obese diabetic patients, patients and their physicians were willing to accept a 1% to 3% perioperative mortality and significant morbidity for this benefit. Laparoscopic RYGB seemed less morbid, but the learning curve was steep. In 2001, the US Food and Drug Administration approved the adjustable silicone gastric band (LB), and demand for this “safer and less invasive” method exploded, although weight loss was more modest and the effect on diabetes less clear. With improvements in minimally invasive techniques and the certification of centers of excellence, the risk-benefit profile for all types of bariatric surgery has decreased, and the question of what is “best” for a patient remains.

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