Original article
Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI≥50 kg/m²

https://doi.org/10.1016/j.soard.2014.11.022Get rights and content

Abstract

Background

Although laparoscopic sleeve gastrectomy (LSG) was initially described as the first step of a 2-stage procedure for high-risk patients requiring laparoscopic Roux-en-Y gastric bypass (LRYGB), it is now being used as a single-stage procedure. Experience with laparoscopic bariatric surgery is growing, such that LRYGB is increasingly feasible for patients with body mass index (BMI)≥50 kg/m². Nevertheless, outcomes for such category of patients following LSG and LRYGB are lacking. Objective: To compare weight loss and changes in obesity related co-morbidities at one year following LSG with LRYGB in patients with BMI≥50 kg/m². Settings: The prospective database of a single surgery university center was queried for clinical and other relevant data.

Methods

From January 2004 to January 2013, 74 and 285 patients underwent LSG or LRYGB with a BMI≥50 kg/m². At one year, rate of follow-up was 92.8%. Success of surgery was defined as % of excess weight loss (%EWL)≥50% at one year. Logistic regression was used to compute odds ratio (OR) to evaluate the success at one year of surgery.

Results

LSG (N = 74) and LGBP (N = 285) groups did not differ for initial BMI (57.2±7.1 versus 56.7±5.5 kg/m²; P = .52), % of female (64.6% versus 73.7%, P = .13) or major adverse postoperative events (5.7% versus 6.7%; P = .85). At one year, the mean percentage of weight loss (%) (22.0±7.6 versus 30.3±7.4; P<.0001) and percentage of excess weight loss (%) (40.2±15.2 versus 55.0±14.6; P<.0001) and rates of remission of diabetes (47.5% versus 70.7%; P = .01) were greater in the LGBP than LSG group. In multivariate analyses (OR), LSG was an independent factor of failure of weight loss (.12; P< .0001)

Conclusion

After 1 year of follow-up in patients with a BMI≥50 kg/m², LRYGB provides better weight loss and resolution in diabetes than LSG with similar postoperative morbidity. Further long-term studies are needed to confirm these results.

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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