Original articleComparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI≥50 kg/m²
Section snippets
Patients
Since January 2004, all of our patients undergoing LSG or LRYGB have been prospectively included in an electronic database. All procedures performed due to failure of sleeve gastrectomy, vertical banded gastroplasty or loop gastric bypass (mini gastric bypass) were excluded. We retrospectively reviewed this database and identified 359 patients (74 LSG and 285 LRYGB) with a preoperative BMI ≥ 50 kg/m² undergoing bariatric surgery from January 2004 to January 2013. At one year, the rate of
Baseline characteristics
A total of 359 patients with BMI ≥ 50 kg/m² underwent bariatric surgery between January 2004 and January 2013 in our tertiary care unit. They were 74 LSG (group 1) and 285 LRYGB (group 2). Group 1 and group 2 were similar for initial BMI (57.2±7.1 versus 56.7±5.5 kg/m²; P = .52) and rate of female (64.6% versus 73.7%, P = .13). Patients in group 1 were older (45.5±13.7 versus 40.9±12.2; P = .005) and had more diabetes (55.4% versus 34.1%; P = .001) (Table 1).
Surgery and 30-day morbid-mortality
The operative time (in minutes) was
Discussion
We provide, here, the first large study assessing one year outcomes between LSG and LRYGB in patients with preoperative BMI≥50 kg/m². Our results clearly indicate that LRYGB provides better weight loss and resolution of coexisting conditions with an insignificant trend for higher postoperative morbi-mortality. Several studies have compared outcomes between LRYGB and LSG, and these studies included patients with lower BMI than those in our study. Most show similar results for the 2 procedures.
Conclusions
This study indicates that LRYGB allows better weight loss at one year than LSG in patients with BMI ≥ 50 kg/m² with higher resolution of diabetes. LRYGB should be considered as the first choice for patients with BMI ≥ 50 kg/m² or when it is the choice of the patient. However, our data show that LSG is a valuable alternative, and allows substantial weight loss, providing the opportunity for a subsequent, second-stage procedure, especially in the highest risk patients when perioperative
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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Cited by (43)
Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort
2020, Surgery for Obesity and Related DiseasesPerioperative outcomes of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in super-obese and super-super-obese patients: a national database analysis
2019, Surgery for Obesity and Related DiseasesCitation Excerpt :A major controversy in managing SO and SSO patients is which bariatric procedure to offer. While LSG offers a safer operative option based on our results, evidence suggests that LRYGB may be a better option in this patient population as it leads to more weight loss and better control of co-morbid conditions especially type 2 diabetes [33–36]. The estimated percent excess weight loss at 1 year in SSO patients has been reported at 49% for LRYGB and 43% for LSG [28].
Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study
2018, Surgery (United States)Citation Excerpt :There are a limited number of studies with up to 5-year outcomes that have focused on the outcomes of higher-risk or super-obese patients who underwent SG, many with the plan of a second-stage definitive procedure to follow. These studies were either retrospective,16 without comparison group16 or unmatched17-19 or had lacked long-term follow-up.17-19 Even so, the reported weight change, weight change comparison, and obesity-related comorbidity improvement outcomes are similar, for the most part, to this LABS-2 report.
Do patients with higher baseline BMI have improved weight loss with Roux-en-Y gastric bypass versus sleeve gastrectomy?
2018, Surgery for Obesity and Related DiseasesAdjustable gastric banded plication versus sleeve gastrectomy: the role of gastrectomy in weight loss
2018, Surgery for Obesity and Related DiseasesCitation Excerpt :This use of statistical analysis allows our study to compare the data without having to exclude patient data that do not fit exactly into the 3-, 6-, 9-, 12-, 18-, and 24-month follow-up points. With these data, we show that our results mirror weight loss percentages reported for both the SG and the LAGBP in previously published series [17–23]. Another limitation is the smaller follow-up percentages with the SG group.