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Metabolic Parameters, Weight Loss, and Comorbidities 4 Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

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Abstract

Background

Sleeve gastrectomy (LSG) is now the predominant bariatric surgery performed, yet there is limited long-term data comparing important outcomes between LSG and Roux-en-Y gastric bypass (RYGB). This study compares weight loss and impact on comorbidities of the two procedures.

Methods

We retrospectively evaluated weight, blood pressure, hemoglobin A1c, cholesterol, and medication use for hypertension, diabetes, and hyperlipidemia at 1–4 years post-operatively in 380 patients who underwent RYGB and 334 patients who underwent LSG at the University of Michigan from January 2008 to November 2013. Follow-up rates from 714 patients initially were 657 (92%), 556 (78%), 507 (71%), and 498 (70%) at 1–4 years post-operatively.

Results

Baseline characteristics were similar except for higher weight and BMI in LSG. There was greater weight loss with RYGB vs. LSG at all points. Hemoglobin A1c and total cholesterol improved more in RYGB vs. LSG at 4 years. There was greater remission of hypertension and discontinuation of all medications for hypertension and diabetes with RYGB at 4 years.

Conclusions

Weight loss, reduction in medications for hypertension and diabetes, improvements in markers of diabetes and hyperlipidemia, and remission rates of hypertension were superior with RYGB vs. LSG 4 years post-operatively. Choice of bariatric procedures should be tailored to surgical risk, comorbidities, and weight loss goals.

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Acknowledgements

The authors would like to acknowledge the surgeons of the University of Michigan Health System (UMHS) bariatric surgery program who operated on our cohort: Jonathan Finks MD, Justin Dimick MD, and John Birkmeyer MD as well as the physician assistants Kendra Rogers PA-C and Clare Gargaro PA-C. We are also grateful for the dedication and care provided by the entire clinical staff of the UMHS Bariatric Surgery Program and the Division of Metabolism, Endocrinology, and Diabetes. Finally, we would like to thank all of our patients who have participated in the UMHS Bariatric Surgery Program and followed in our post-bariatric surgery clinic.

Funding

The study was supported by the Parker Family Foundation and the University of Michigan Health System as discretionary funding to Dr. Oral.

Author information

Authors and Affiliations

  1. Division of Metabolism, Endocrinology, and Diabetes, Brehm Center for Diabetes, Michigan Medicine, 24 Frank Lloyd Wright Drive, Domino’s Farm, Lobby C, Ann Arbor, MI, 48106, USA

    Corey J. Lager, Nazanene H. Esfandiari, Andrew T. Kraftson, Rasimcan Meral, Catherine K. Nay, Amy L. Lockwood, Darlene Bellers & Elif A. Oral

  2. Department of Endocrinology, Peking University People’s Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China

    Yingying Luo

  3. Division of Endocrinology, University of Mississippi, 2500 N State St, Jackson, MS, 39216, USA

    Angela R. Subauste

  4. School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA

    Morton B. Brown

  5. Division of Minimally Invasive Surgery, Department of General Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Oliver A. Varban, Ruth B. Cassidy & Colleen M. Buda

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  1. Corey J. Lager
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  2. Nazanene H. Esfandiari
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  14. Elif A. Oral
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Corresponding author

Correspondence to Elif A. Oral.

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Conflict of Interest

Dr. Kraftson is a clinical investigator for a study sponsored by Nestle. Dr. Varban receives salary support from Blue Cross Blue Shield of Michigan for leading quality improvement efforts within the Michigan Bariatric Surgery Collaborative. Dr. Oral has received grant support from Aegerion Pharmaceuticals, Ionis Pharmaceuticals, Akcea Therapeutics, Gemphire, GI Dynamics, and AstraZeneca; has been a consultant or advisor for AstraZeneca, BMS, TheraTherapeutics, Regeneron, and Aegerion; and has received drug or other nonmaterial support from Aegerion Pharamaceuticals, Akcea Therapeutics, Rhythm Pharmaceuticals, and Boehringer Ingelheim. All other authors have no conflict of interest to disclose.

Ethics

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent Statement

This retrospective data analysis is exempt from informed consent. Our study was approved by the IRB prior to any data collection.

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Lager, C.J., Esfandiari, N.H., Luo, Y. et al. Metabolic Parameters, Weight Loss, and Comorbidities 4 Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. OBES SURG 28, 3415–3423 (2018). https://doi.org/10.1007/s11695-018-3346-1

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