Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose?

Dietary management of obesity, based on modification of eating patterns, increased physical activity and psychological and social support has provided inconsistent and disappointing results. Surgery is an invasive and often irreversible alternative that offers substantial and durable weight loss at the price of non-negligible morbidity and mortality. Three procedures account for almost all bariatric surgical procedures in France: adjustable gastric banding (AGB), vertical or sleeve gastrectomy (SG), and gastric bypass (GBP). The goal of this review is to help the surgeon make the best choice among these procedures, depending on his surgical convictions, abilities, and habits. Evidence-based data were extracted from the literature using the major data-base resources (Medline, Web of knowledge, Scopus); as well the most recent recommendations from relevant learned societies and health care organisms were analyzed. In 2010, 26,558 bariatric operations were performed in France; these were more or less equally distributed between AGB, SG and GBP. In 2011, the proportion of SG increased enormously and represented 43.9% of all bariatric procedures. In terms of weight loss and perioperative morbidity/mortality, SG tends to stand midway between AGB and GBP.