Skip to main content
SpringerLink
Log in

Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Lead to Comparable Changes in Body Composition after Adjustment for Initial Body Mass Index

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment.

Methods

One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n = 127, mean body mass index (BMI) 45.7 ± 5.7 kg/m2) or sleeve gastrectomy (SG; n = 46, mean BMI 55.9 ± 7.8 kg/m2) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis.

Results

After 1 year of observation, %EWL was 62.9 ± 18.0 % in RYGB and 52.3 ± 15.0 % in SG (p = 0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7 ± 8.4 % in RYGB and 30.5 ± 7.6 % in SG patients, p > 0.4).

Conclusions

Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  2. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    Article  PubMed  Google Scholar 

  3. Sjöström L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  4. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m2. Obes Surg. 2011;21:1650–6.

    Article  PubMed  Google Scholar 

  5. Woelnerhanssen B, Peterli R, Steinert RE, et al. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy—a prospective randomized trial. Surg Obes Relat Dis. 2011;7:561–8.

    Article  PubMed  Google Scholar 

  6. Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS). A prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258:690–5.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Strain GW, Gagner M, Pomp A, et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009;5(5):582–7.

    Article  PubMed  Google Scholar 

  8. Zalesin KC, Franklin BA, Lillystone MA, et al. Differential loss of fat and lean mass in the morbidly obese after bariatric surgery. Metab Syndr Relat Disord. 2010;8(1):15–20.

    Article  PubMed  Google Scholar 

  9. Faria SL, Faria OP, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21:1798–805.

    Article  PubMed  Google Scholar 

  10. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  CAS  PubMed  Google Scholar 

  11. Runkel N, Colombo-Benkmann M, Hüttl TP, et al. Evidence-based German guidelines for surgery for obesity. Int J Color Dis. 2011;26(4):397–404.

    Article  Google Scholar 

  12. Thomson R, Brinkworth GD, Buckley JD, et al. Good agreement between bioelectrical impedance and dual-energy X-ray absorptiometry for estimating changes in body composition during weight loss in overweight young women. Clin Nutr. 2007;26(6):771–7.

    Article  PubMed  Google Scholar 

  13. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis part I: review of principles and methods. Clin Nutr. 2004;5:1226–43.

    Article  Google Scholar 

  14. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  15. Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713–23.

    Article  PubMed  Google Scholar 

  16. Hawasli A, Jacquish B, Almahmeed T, et al. Early effects of bougie size on sleeve gastrectomy outcome. Am J Surg. 2015;209(3):473–7.

    Article  PubMed  Google Scholar 

  17. Yuval JB, Mintz Y, Cohen MJ, et al. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013;23(10):1685–91.

    Article  PubMed  Google Scholar 

  18. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  19. Van de Laar A, de Caluwé L, Dillemans B. Relative outcome measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obes Surg. 2011;21(6):763–7.

    Article  PubMed  Google Scholar 

  20. Friedrich AE, Damms-Machado A, Meile T, et al. Laparoscopic sleeve gastrectomy compared to a multidisciplinary weight loss program for obesity—effects on body composition and protein status. Obes Surg. 2013;23:1957–65.

    Article  PubMed  Google Scholar 

  21. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery. Obesity. 2013;21:1–27.

    Article  Google Scholar 

  22. Buchholz AC, Bartok C, Schoeller DA. The validity of bioelectrical impedance models in clinical populations. Nutr Clin Pract. 2004;19(5):433–46.

    Article  PubMed  Google Scholar 

  23. Bosy-Westphal A, Later W, Hitze B, et al. Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry. Obes Facts. 2008;1(6):319–24.

    Article  PubMed  Google Scholar 

  24. Frisard MI, Greenway FL, Delany JP. Comparison of methods to assess body composition changes during a period of weight loss. Obes Res. 2005;13:845–54.

    Article  PubMed  Google Scholar 

  25. Deurenberg P. Limitations of the bioelectrical impedance method for the assessment of body fat in severe obesity. Am J Clin Nutr. 1996;64(3 suppl):449S–52.

    CAS  PubMed  Google Scholar 

  26. Segal KR, Van Loan M, Fitzgerald PI, et al. Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J Clin Nutr. 1988;47:7–14.

    CAS  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

Approval from the local institutional review board (IRB) was obtained and is in agreement with the Helsinki declaration.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, UMM, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany

      Mirko Otto, Mohamad Elrefai, Johannes Krammer & Peter Kienle

    2. Department of Medical Statistics, Biomathematics and Information Processing, Heidelberg University, Mannheim, Germany

      Christel Weiß

    3. Department of Surgery, Alfried Krupp Krankenhaus, Essen, Germany

      Till Hasenberg

    Authors
    1. Mirko Otto
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Mohamad Elrefai
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Johannes Krammer
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Christel Weiß
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Peter Kienle
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Till Hasenberg
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Mirko Otto.

    Additional information

    Mirko Otto and Mohamad Elrefai contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Otto, M., Elrefai, M., Krammer, J. et al. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Lead to Comparable Changes in Body Composition after Adjustment for Initial Body Mass Index. OBES SURG 26, 479–485 (2016). https://doi.org/10.1007/s11695-015-1792-6

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11695-015-1792-6

    Keywords

    Search

    Navigation