Sleeve Gastrectomy Versus Intragastric Balloon

In a recent study by Genco and Colleagues (Surgical Endoscopy, Volume 23, pg. 1849-1853, 2009) a bariatric center compared the effectiveness of laparoscopic sleeve gastrectomy against the Bioenterics Intragastric Balloon (BIB) with twelve months of follow-up.

The mean surgical time for the sleeve gastrectomy was 120 minutes. The mean endoscopy or balloon positioning time was around 15 minutes for the BIB. Prior to surgery, the body mass index was 54.1 for the BIB group and 54.8 for the sleeve gastrectomy group. At six months follow-up time, the BMI had fallen to 46 for the BIB group and 45 for the sleeve gastrectomy group. At twelve months, the BMI for the BIB has risen to 48 kg/m² and the BMI for the sleeve gastrectomy had fallen to 43 kg/m². Eighty patients underwent the BIB procedure and 40 patients underwent the sleeve gastrectomy procedure. Failure of weight loss (defined as weight loss of less than 10%) was similar in both groups (2 out of 40 for the sleeve gastrectomy and 4 out of 80 for the BIB procedure.

These authors conclude that the BIB procedure is considered a preferred option for a “first step procedure” for patients with high surgical risk or for patients with high body mass index (super obese BMI greater than 50) or for patients who plan to undergo a more complex bariatric procedure.

The Bioenterics Intragastric Balloon has emerged as a valid option in treatment of morbid obesity in certain circumstances. For example, author Bufetto demonstrated that placement of the BIB as a first step reduced the subsequent risk of conversion to open surgery during the eventual bariatric surgical procedure. It also reduced the risk of intra-operative complications in “super obese” patients, those who had a body mass index over 50. (Bufetto, L., Pre-operative Weight Loss by Intragastric Balloon in Super Obese Patients Treated with Laparoscopic Gastric Banding: A Case Controlled Study, Obesity Surgery, Volume 14, pg. 671-676, 2004)

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