Our bariatric unit has just published a comparison of outcome of the three most common weight loss procedures performed in the public hospital system through Box Hill Hospital, Victoria. At Box Hill Hospital we have been offering a choice of gastric banding, sleeve gastrectomy and gastric bypass surgery since around 2007 for public patients without private health insurance.
Government funded bariatric surgery is difficult to access in Australia with waiting lists stretching to several years in order just to see one of the surgical team.
We examined the outcomes of the three operations at Box Hill over a five year period.
Overall, gastric bypass was found to have the greatest weight loss for patients with percentage of Excess Weight Lost = 75.7%. Sleeve gastrectomy was next most effective with 52.7% and the gastric band the least reliable with %EWL 29.9%. Gastric bypass was also the most complex procedure with longest operating times and highest complication rates.
Although gastric band procedures are relatively quick to perform with patients staying on average just one night in hospital (compared to 4 or 5 for sleeve gastrectomy or bypass) the results have been relatively poor at Box Hill. Perhaps this is because clinic appointments cannot be as frequent as in the private system or maybe because many patients are from long distances and find it difficult to attend.
At Box Hill, therefore, sleeve gastrectomy is now the most commonly performed procedure. Its reliability is better than the band and complication rates lower than the bypass making it a good compromise between reliability and risk.
These results are the work of a team of half a dozen surgical trainees and will aid other units seeking to establish public bariatric programs in this country.