A comparison of the gastric bypass and the gastric wrap for morbid obesity.

The standard for surgical treatment of morbid obesity is gastric reservoir reduction (GRR). The two popular techniques for GRR are the gastric bypass (GBP) and vertical banded gastroplasty. In 1981, a new approach to GRR, namely, the gastric wrap (GW) was introduced. The GW envelops the stomach in a customized Teflon (polytetrafluoroethylene) mesh. The current study compares, for the first time, the long term efficacy of GW and GBP. One hundred and five morbidly obese patients were studied. Fifty-two patients had GBP and 53 had GW. Preoperative and ideal weights averaged 301 and 129 pounds in the GW patients versus 278 and 123 pounds in the GBP patients. The two groups had similar age, height and co-morbid conditions. All patients survived the operation. After discharge, the patients had follow-up examinations at two weeks, two months, six months and then yearly. The GW was significantly more effective than the GBP in attaining and maintaining weight loss. The increased percent excess weight loss (percent EWL) was statistically significant at 12 months when the GW patients achieved 67 percent EWL compared with 57 percent EWL in the GBP patients. After the third year, the percent of EWL declined in the GBP patients, averaging 48 percent at four years and 47 percent at five years. In contrast, the GW patients maintained a 72 percent EWL at four years and a 66 percent EWL at five years. This weight loss was accomplished without nutritional embarrassment in both groups. The superiority of the GW in achieving and maintaining weight loss is reflected by the opinions of the patients regarding the attainment of preoperative objectives and their willingness to recommend GW to others. The downside of the GW is the higher incidence of reversal and the increased technical difficulties with reversal or revision compared with the GBP.