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Roux-en-Y Gastric Bypass Is More Effective than Sleeve Gastrectomy in Improving Postprandial Glycaemia and Lipaemia in Non-diabetic Morbidly Obese Patients: a Short-term Follow-up Analysis

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Abstract

Purpose

We aimed to compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on postprandial glucose and lipid metabolism in addition to weight loss and fasting metabolic profile, in non-diabetic patients undergoing bariatric surgery.

Methods

Seventy-one patients were consecutively recruited and studied preoperatively, 3 and 6 months after surgery. Of these, 28 underwent RYGB (7 males, age 38 ± 9 years, BMI 46.9 ± 5.0 kg/m2), and 43 SG (9 males, age 38 ± 9 years, BMI 50.2 ± 7.0 kg/m2). A semi-liquid mixed meal was consumed, and blood samples were taken before, and every 30 min after meal ingestion up to 180 min postprandially, for measurement of glucose, insulin, and lipids. The overall postprandial response was assessed as area under the concentration-time curve (AUC).

Results

Baseline metabolic parameters were similar between RYGB and SG. Both groups experienced comparable weight loss, and a similar improvement in fasting glucose, insulin, and insulin resistance. Total and LDL cholesterol levels were lower at 6 months after RYGB compared to SG, while there was no difference in HDL cholesterol or triglycerides. Glucose AUC was lower after RYGB compared to SG at both 3 (p = 0.008) and 6 months (p = 0.016), without any difference in postprandial insulin response. Triglyceride AUC was also lower in RYGB vs. SG at 3 and 6 months (p ≤ 0.001).

Conclusions

RYGB is superior to SG in improving postprandial glycaemia and lipaemia and cholesterol profile 6 months postoperatively in non-diabetic, severely obese patients. These findings imply procedure-specific effects, such as the malabsorptive nature of RYGB, and less likely a different incretin postoperative response.

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Author notes

  1. Christos Liaskos and Chrysi Koliaki contributed equally to this work.

Authors and Affiliations

  1. First Department of Propaedeutic Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece

    Christos Liaskos, Chrysi Koliaki, Kleopatra Alexiadou, Georgia Argyrakopoulou, Nicholas Tentolouris, Nicholas Katsilambros & Alexander Kokkinos

  2. First Department of Surgery, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Theodoros Diamantis & Andreas Alexandrou

Authors
  1. Christos Liaskos
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  2. Chrysi Koliaki
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  3. Kleopatra Alexiadou
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  4. Georgia Argyrakopoulou
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  5. Nicholas Tentolouris
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  6. Theodoros Diamantis
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  7. Andreas Alexandrou
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  8. Nicholas Katsilambros
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  9. Alexander Kokkinos
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Corresponding author

Correspondence to Chrysi Koliaki.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

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

Electronic Supplementary Material

Supplementary Figure 1

Postprandial time course of insulin during the mixed meal test (a) at baseline, (b) 3 months and (c) 6 months after RYGB and SG. (d) Total area under the curve (AUC) for postprandial insulin (0-180 minutes). Data are presented as mean±SEM. Panels a-c: Black triangles represent RYGB and grey squares represent SG group; the level of statistical significance was defined as p <0.05/7=0.007 (Bonferroni correction for 7 time points) Panel d: dark grey columns represent RYGB and light grey columns represent SG; the level of statistical significance was defined as p <0.05/3=0.017 (Bonferroni correction for 3 time points). p=ns (non-significant) for RYGB vs. SG at any time point. AUC: area under the curve; RYGB: Roux-en-Y Gastric Bypass; SG: Sleeve Gastrectomy (DOCX 35 kb)

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Liaskos, C., Koliaki, C., Alexiadou, K. et al. Roux-en-Y Gastric Bypass Is More Effective than Sleeve Gastrectomy in Improving Postprandial Glycaemia and Lipaemia in Non-diabetic Morbidly Obese Patients: a Short-term Follow-up Analysis. OBES SURG 28, 3997–4005 (2018). https://doi.org/10.1007/s11695-018-3454-y

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