Advertisement

Obesity Surgery

, Volume 21, Issue 12, pp 1834–1842 | Cite as

Effects of Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on Weight Loss and Biomarker Parameters in Morbidly Obese Patients: A 12-Month Follow-Up

  • Karamollah Toolabi
  • Saeed ArefanianEmail author
  • Mahdieh Golzarand
  • Hossein Arefanian
Clinical Research

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is suggested as the gold standard of the surgical techniques for morbid obesity treatment. The aim of this study was to evaluate the weight loss and biomarker parameter changes over a 1-year period following LRYGB in Iranian morbidly obese patients.

Methods

Sixty patients who had undergone LRYGB from June 2006 to August 2008 were followed up. Complication rates and changes in anthropometric indices, metabolic parameters, and obesity-related comorbidities were evaluated.

Results

During the mean follow-up duration of 27.2 ± 9.4 months, the mean weight reduced from 128.8 ± 20.4 to 86.9 ± 12.7 kg with excess weight loss (%EWL) of 63.8 ± 15.6%. The male young-adolescent patients showed more weight loss than females. Biochemical parameter changes were reduction of fasting blood sugar by 19%, total cholesterol by 17%, triglyceride by 30%, low-density lipoprotein by 19%, aspartate aminotransferase by 44%, alanine aminotransferase by 52%, alkaline phosphatase by 33%, and uric acid by 19%, while high-density lipoprotein (HDL) levels increased by 22%. HDL level change was the only biomarker factor showing correlation with age (P = 0.005, r = −0.353, R 2 = 0.125). Obesity comorbidities were resolved considerably. There were two cases of surgical complications and no case of mortality.

Conclusion

LRYGB appears to be a safe and effective procedure with a low complication rate in Iranian morbidly obese patients. It results in weight loss, reduction in obesity comorbidities, increasing HDL, and decreasing other measured plasma biochemical parameters. Based on our results, we suggest that LRYGB would benefit young male morbidly obese patients more than others.

Keywords

Morbid obesity Gastric bypass Hyperlipidemias Comorbidity Weight loss Hyperglycemia Liver function tests Uric acid 

Notes

Acknowledgments

The authors wish to thank Dr. Foad Ahmadi and Dr. Tohid Emami for their help and comments in preparing this article.

Conflicts of Interest

All contributing authors (K.T., S.A., M.G., and H.A.) declare that they have no conflicts of interest.

References

  1. 1.
    Alegría Ezquerra E, Castellano Vázquez JM, Alegría Barrero A. Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy. Rev Esp Cardiol. 2008;61(7):752–64.PubMedCrossRefGoogle Scholar
  2. 2.
    Mathew B, Francis L, Kayalar A, et al. Obesity: effects on cardiovascular disease and its diagnosis. J Am Board Fam Med. 2008;21(6):562–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann Acad Med Singapore. 2009;38(1):57–9.PubMedGoogle Scholar
  4. 4.
    Nahleh Z, Bhatti NS, Mal M. How to reduce your cancer risk: mechanisms and myths. Int J Gen Med. 2011;4:277–87.PubMedGoogle Scholar
  5. 5.
    Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S9–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Elks CM, Francis J. Central adiposity, systemic inflammation, and the metabolic syndrome. Curr Hypertens Rep. 2010;12(2):99–104.PubMedCrossRefGoogle Scholar
  7. 7.
    Hosseinpanah F, Barzin M, Eskandary PS, et al. Trends of obesity and abdominal obesity in Tehranian adults: a cohort study. BMC Public Health. 2009;9:426.PubMedCrossRefGoogle Scholar
  8. 8.
    Heshmat R, Khashayar P, Meybodi HR, et al. The appropriate waist circumference cut-off for Iranian population. Acta Med Indones. 2010;42(4):209–15.PubMedGoogle Scholar
  9. 9.
    Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.PubMedCrossRefGoogle Scholar
  10. 10.
    O'Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol. 2010;25(8):1358–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Hofsø D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45.PubMedCrossRefGoogle Scholar
  12. 12.
    Sears D, Fillmore G, Bui M, et al. Evaluation of gastric bypass patients 1 year after surgery: changes in quality of life and obesity-related conditions. Obes Surg. 2008;18(12):1522–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158(2):135–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith BR, Schauer P, Nguyen NT. Surgical approaches to the treatment of obesity: bariatric surgery. Endocrinol Metab Clin North Am. 2008;37(4):943–64.PubMedCrossRefGoogle Scholar
  15. 15.
    Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity: what fits whom? Diabetes Care. 2008;31 Suppl 2:S269–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Vagenas K, Panagiotopoulos S, Kehagias I, et al. Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity. World J Gastroenterol. 2008;14(39):6024–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Huang CK, Yao SF, Lo CH, et al. A novel surgical technique: single-incision transumbilical laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(10):1429–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Dillemans B, Sakran N, Van Cauwenberge S, et al. Standardization of the fully stapled laparoscopic Roux-en-Y gastric bypass for obesity reduces early immediate postoperative morbidity and mortality: a single center study on 2606 patients. Obes Surg. 2009;19(10):1355–64.PubMedCrossRefGoogle Scholar
  19. 19.
    Myers VH, Adams CE, Barbera BL, et al. Medical and psychosocial outcomes of laparoscopic Roux-en-Y gastric bypass: cross-sectional findings at 4-year follow-up. Obes Surg. 2010 Dec 7. [Epub ahead of print]Google Scholar
  20. 20.
    Coupaye M, Sabaté JM, Castel B, et al. Predictive factors of weight loss 1 year after laparoscopic gastric bypass in obese patients. Obes Surg. 2010;20(12):1671–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Mutch DM, Fuhrmann JC, Rein D, et al. Metabolite profiling identifies candidate markers reflecting the clinical adaptations associated with Roux-en-Y gastric bypass surgery. PLoS One. 2009;4(11):e7905.PubMedCrossRefGoogle Scholar
  22. 22.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991; 115(12):956–61.Google Scholar
  23. 23.
    Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMedGoogle Scholar
  25. 25.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–89.PubMedCrossRefGoogle Scholar
  26. 26.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.PubMedCrossRefGoogle Scholar
  27. 27.
    DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235(5):640–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Han SH, Gracia C, Mehran A, et al. Improved outcomes using a systematic and evidence-based approach to the laparoscopic Roux-en-Y gastric bypass in a single academic institution. Am Surg. 2007;73(10):955–8.PubMedGoogle Scholar
  30. 30.
    Lakdawala MA, Bhasker A, Mulchandani A, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010;20(1):1–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Hauser DL, Titchner RL, Wilson MA, et al. Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans. Obes Surg. 2010;20(3):283–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Stanford A, Glascock JM, Eid GM, et al. Laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents. J Pediatr Surg. 2003;38(3):430–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.PubMedGoogle Scholar
  34. 34.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg. 2000;10(3):233–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg. 2000;10(6):509–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Nguyen NT, Cronan M, Braley S, et al. Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc. 2003;17(2):285–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004;240(6):975–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Nguyen NT, Varela E, Sabio A, et al. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203(1):24–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Johansson HE, Haenni A, Ohrvall M, et al. Alterations in proinsulin and insulin dynamics, HDL cholesterol and ALT after gastric bypass surgery. A 42-months follow-up study. Obes Surg. 2009;19(5):601–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Jouet P, Sabate JM, Maillard D, et al. Relationship between obstructive sleep apnea and liver abnormalities in morbidly obese patients: a prospective study. Obes Surg. 2007;17(4):478–85.PubMedCrossRefGoogle Scholar
  41. 41.
    Prati D, Taioli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137(1):1–10.PubMedGoogle Scholar
  42. 42.
    Serpa Neto A, Rossi FM, Valle LG, et al. Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects. Arq Bras Endocrinol Metabol. 2011;55(1):38–45.PubMedCrossRefGoogle Scholar
  43. 43.
    Burgio KL, Richter HE, Clements RH, et al. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110(5):1034–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Karamollah Toolabi
    • 1
  • Saeed Arefanian
    • 2
    • 5
    Email author
  • Mahdieh Golzarand
    • 3
  • Hossein Arefanian
    • 4
  1. 1.Department of Surgery, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
  2. 2.School of MedicineTehran University of Medical SciencesTehranIran
  3. 3.Obesity Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Endocrinology and Metabolism Research Center, Dr. Shariati HospitalTehran University of Medical SciencesTehranIran
  5. 5.TehranIran

Personalised recommendations