Based in a review of the recent evidence, the ICSI Technology Assessment Committee concludes the following:
Gastric surgery may be considered for patients 18 years of age or older, with a body mass index (BMI) >= 40 kg/m2 or a BMI >= 35 kg/m2 with comorbid conditions, and who have failed maximal medical therapy.
Vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB) are the surgeries currently being done in the United States. Both are generally safe (mortality <1.5% in experienced centers).
There is evidence in the literature that both procedures result in weight loss that may be sustained for seven years or longer. (Conclusion Grade II)
While many of the studies are case series, there are also prospective cohort studies.
There are clinical trials showing improvements in glucose tolerance, forms of hyperlipidemia, hypertension, and arthritis. (Conclusion Grade I)
There remains a need for long-term trials to demonstrate long-term survival benefit and long-term maintenance of both weight loss and reversal of comorbidities.
Although some reports suggest that RYGB may be more durable than VBG in terms of maintenance of weight loss and reversal of comorbidities, there is insufficient data, to date, to strongly support that suggestion.
Patients who have VBG or RYGB should be followed by a multidisciplinary team with lifelong medical surveillance for nutrient deficiencies and medical complications.