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Metabolic effects and outcomes of sleeve gastrectomy and gastric bypass: a cohort study

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Abstract

Background

The outcomes of bariatric surgery should not be evaluated only for weight loss purposes but from a wider point of view that is closer to the reality of morbidly obese patients. The study of the influence of bariatric surgery over obesity-related diseases in bariatric patients is worthwhile.

Methods

We present a cohort study of 329 patients who underwent either laparoscopic sleeve gastrectomy (LSG: 165 patients) or laparoscopic gastric bypass (LRYGBP: 164). We analyzed complication rate, comorbidities and weight loss evolution.

Results

Both groups were comparable in demographic characteristics at baseline. Significant statistical differences were found in length of hospital stay and operative time (both were lower in the LSG group). Bleeding and wound infection were higher in the LRYGBP group, as it happened with intestinal occlusion as a late complication (p < 0.05). After a 5-year follow-up, the percentage of excess weight loss (%EWL) was higher in gastric bypass than sleeve gastrectomy (p = 0.01) but there was no statistical difference in percentage of total weight loss (%TWL) (p = 0.2). The resolution of comorbidities was similar in both groups except for dyslipidemia, which resolution was significantly higher in the gastric bypass group (p = 0.005). Metabolic syndrome (MeTS) resolution was similar in both groups.

Conclusions

Sleeve gastrectomy and gastric bypass achieve similar outcomes in hypertension, type 2 diabetes, obstructive sleep apnea and MeTS resolution even when there is weight regain. Although gastric bypass achieves higher weight loss in morbid obese patients, complication rates are also higher compared to those of sleeve gastrectomy. Thus, the appropriate procedure should be tailored based on patient factors and comorbidities, but also on surgeon comfort level and experience.

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References

  1. 1.

    Ng M, Fleming TRM (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766

  2. 2.

    Zhang Y, Ju W, Sun X, Cao Z, Xinsheng X, Liu D et al (2015) Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg 25:19–26

  3. 3.

    Deitel M, Crosby RD, Gagner M (2018) The first international consensus summit for sleeve gastrectomy. Obes Surg 18:487–496

  4. 4.

    Dogan K, Gadiot RP, Aarts EO, Betzel B, van Laarhoven CJ, Biter LU et al (2015) Effectiveness and safety of sleeve gastrectomy, gastric bypass and adjustable gastric banding in morbidly obese patients: a multicenter, retrospective, matched cohort study. Obes Surg 25:1110–1118

  5. 5.

    Chang SH, Cr S, Song J, Varela JE, Eaogon CJ, Colditz GA (2014) The effectiveness and risks of bariatric surgery: and updated systematic review and meta-analysis, 2003–2012. JAMA Surg 149:275–287

  6. 6.

    Trastulli S, Desiderio J, Guarino S, Cirocchi R, Scalercio V, Noya G et al (2013) Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis 9:816–829

  7. 7.

    Leyba JL, Navarrete Llopis S, Navarrete Aulestia S (2014) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study with 5 years of follow-up. Obes Surg 24:2094–2098

  8. 8.

    Alexandrou A, Athanasiou A, Michalinos A, Felekouras E, Tesigris C, Diamantis T (2015) Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results. Am J surg 209:230–234

  9. 9.

    Hong JS, Kim WW, Han SM (2015) Five year results of laparoscopic sleeve gastrectomy in Korean patients with lower body mass index (30–35 kg m/2). Obes Surg 25:824–829

  10. 10.

    Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A et al (2015) Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis 11:489–506

  11. 11.

    Conference NIH (1991) Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med 115:956–961

  12. 12.

    Zimmet P, Alberti KSM (2005) Una nueva definición mundial del síndrome metabólico propuesta por la Federación Internacional de Diabetes: fundamento y resultados. Rev Esp Cardiol 58:1371–1376

  13. 13.

    Baltasar A, Bou R, Del Río J, Bengoechea M, Escriva C, Miro J et al (1997) Cirugía Bariátrica: Resultados a largo plazo de la gastrectomía vertical anillada. Cir Esp 62:175–179

  14. 14.

    Deitel MGM (2003) Recommendations for reporting weight loss. Obes Surg 13:159–160

  15. 15.

    Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss in patients with morbid obesity. The SM-BOSS randomized clinical trial. JAMA 319:255–265

  16. 16.

    Salminem P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, Hurme S et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss at 5 years among patients with morbid obesity. The SLEEVEPASS randomiced clinical trial. JAMA 319:241–254

  17. 17.

    Diamantis T, Apostolou KG, Alexandrou A, Griniatsos J, Felekouras E, Tsigris C (2014) Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 10:177–183

  18. 18.

    Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252:319–324

  19. 19.

    Li J, Lai D, Wu D (2016) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg 26:429–442

  20. 20.

    Rondelli F, Bugiantella W, Vedovati MC, Mariani E, Balzarotti Canger RC, Federici S et al (2017) Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy: a retrospective multicenter comparision between early and long term post-operative outcomes. Int J Surg 37:36–41

  21. 21.

    Ignat M, Vix M, Imad I, D’Urso A, Perretta S, Marescaux J, et al (2017) Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg 104:248–256

  22. 22.

    Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M (2013) Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg 257:231–237

  23. 23.

    Vidal P, Ramón JM, Goday A, Benaiges D, Trillo L, Parri A et al (2013) Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity Mind-term results. Obes Surg 23:292–299

  24. 24.

    Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN (2014) Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared to laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 208(6):903–910

  25. 25.

    Boza C, Gamboa C, Salinas J, Achurra P, Vega A, Pérez G (2012) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis 8:243–249

  26. 26.

    Ma IT, Madura JA (2015) Gastrointestinal complications after bariatric surgery. Gastroenterol Hepatol 11(8):526–535

  27. 27.

    Quesada B, Kohan G, Roff H, Canullan C, Chiappetta L (2010) Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol 16:2075–2079

  28. 28.

    Yip S, Plank LD, Murphy R (2013) Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Sur 23:1994–2003

  29. 29.

    Melissas J, Koukouraki S, Ascoxilakis J, Stathaki M, Daskalakis M, Perisinakis K et al (2007) Sleeve gastrectomy: a restrictive procedure? Obes Surg 17:57–62

  30. 30.

    Braghetto I, Davanzo C, Korn O, Csendes A, Valladares H, Herrera E et al (2009) Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjets. Obes Surg 19:1515–1521

  31. 31.

    Rubino F, Marescaux J (2004) Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 239:1–11

  32. 32.

    Sarkosh K, Switzer NJ, El-Hadi M, Birch DW, Shi W, Karmali S (2013) The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg 23:414–423

  33. 33.

    Nagendran M, Carlin AM, Bacal D, Genaw JA, Hawasli AA, Birkmeyer NJ et al (2015) Self-reported remission of obstructive sleep apnea following bariatric surgery: cohort study. Surg Obes Relat Dis 11:697–703

  34. 34.

    Recomendaciones de la SECO para la práctica de la cirugía bariátrica (Declaración de Salamanca) (2014). Cir Esp 75:312–314.

  35. 35.

    Gracia JA, Martinez M, Aguilella V, Elía M, Royo P (2007) Postoperative morbidity of biliopancreatic diversión depending on common limb length. Obes Surg 17:1306–1311

  36. 36.

    Larrad A, Sánchez-Cabezudo C (2004) Quality indicators in bariatric surgery and criteria for long-term success. CirEsp 75:301–304

  37. 37.

    Golzarand M, Toolabi K, Farid R (2017) The bariuatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopicadjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 11:4331–4345

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Author information

Correspondence to B. Calvo.

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Disclosures

All authors, Calvo B, Gracia JA, Bielsa MA, Martinez M, have nothing to disclose, neither relationships with pharmaceutical nor device companies.

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Cite this article

Calvo, B., Gracia, J.A., Bielsa, M.A. et al. Metabolic effects and outcomes of sleeve gastrectomy and gastric bypass: a cohort study. Surg Endosc (2020) doi:10.1007/s00464-019-07355-z

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Keywords

  • Obesity
  • Bariatric surgery
  • Sleeve gastrectomy
  • Gastric bypass
  • Metabolic surgery