Obesity Surgery

, Volume 22, Issue 8, pp 1268–1275 | Cite as

Impact of Restrictive (Sleeve Gastrectomy) vs Hybrid Bariatric Surgery (Roux-en-Y Gastric Bypass) on Lipid Profile

  • D. BenaigesEmail author
  • J. A. Flores-Le-Roux
  • J. Pedro-Botet
  • J. M. Ramon
  • A. Parri
  • M. Villatoro
  • M. J. Carrera
  • M. Pera
  • E. Sagarra
  • L. Grande
  • A. Goday
  • On behalf the Obemar Group
Clinical Research



Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile, with the results being contradictory. The effect of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on lipid profile was compared.


A nonrandomized prospective cohort study was conducted on severely obese patients undergoing bariatric surgery. Indication for the type of surgical procedure was based on clinical criteria. Patients on lipid-lowering drugs and those that could not be matched for age, sex, and body mass index were excluded. Finally, 51 patients who underwent LSG and 51 undergoing LRYGB completed this study.


During the first year post-surgery, no differences in percentage of excess weight loss and triglyceride reduction were found between groups. After LRYGR, low-density lipoprotein (LDL) cholesterol concentrations fell significantly (125.9 ± 29.3 to 100.3 ± 26.4 mg/dl, p < 0.001), whereas no significant changes were observed in the LSG group (118.6 ± 30.7 to 114.6 ± 33.5 mg/dl, p = 0.220). High-density lipoprotein (HDL) cholesterol increase was significantly greater after LSG (15.4 ± 13.1 mg/dl) compared with LRYGB (9.4 ± 14.0 mg/dl, p = 0.032). Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB. A greater increase in HDL cholesterol was associated with LSG, older age, and baseline HDL cholesterol.


LRYGB produces an overall improvement in lipid profile, with a clear benefit in all lipid fractions. Although LSG does not alter LDL cholesterol levels, its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques.


Laparoscopic sleeve gastrectomy Laparoscopic Roux-en-Y gastric bypass Lipid profile Cholesterol Triglyceride 



We thank Miss Christine O’Hara for review of the English version of the manuscript. This work was supported partially by a research grant to Alberto Goday from the Fondo de Investigación Sanitaria–Evaluación Tecnologías Médicas (no PI 08/90638), Instituto de Salud Carlos III, Ministry of Health, Spain.

OBEMAR group members: Department of Anaesthesiology, Hospital del Mar, Barcelona (L Trillo); Department of Clinical Pharmacology (M Farre, R de la Torre); Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona (D Benaiges, J. Cano, MJ Carrera, JJ Chillaron, C Claret, JA Flores, A Goday, E Hernandez, A Parri, J Pedro-Botet, J Puig, E Sagarra, M Villatoro); Department of Psychiatry, Hospital del Mar, Barcelona (S Ros); Institut Municipal d’Investigació Mèdica (IMIM) (MI Covas, H Shroeder), Unit of Gastrointestinal Surgery, Hospital del Mar, Barcelona (L Grande, M Pera, JM Ramon).


  1. 1.
    Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Qual Life Res. 2008;17:1063–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Leyba JL, Aulestia SN, Llopis SN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of severe obesity. A prospective study of 117 patients. Obes Surg. 2010;21:212–6.CrossRefGoogle Scholar
  6. 6.
    Birkmeyer NJ, Dimick JB, Share D, et al. Michigan Bariatric Surgery Collaborative. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304:435–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2009;24:1005–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Gill RS, Karmali S, Sharma AM. Treating type 2 diabetes mellitus with sleeve gastrectomy in obese patients. Obesity. 2011;19:701–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1year study. Obes Surg. 2010;20:1–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Vidal J, Ibarzabal A, Nicolau J, et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007;17:1069–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Athyros VG, Tziomalos K, Karagiannis A, et al. Cardiovascular benefits of bariatric surgery in morbidly obese patients. Obes Rev. 2011;12:515–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Dhabuwala A, Cannan RJ, Stubbs RS. Improvement in co-morbidities following weight loss from gastric bypass surgery. Obes Surg. 2000;10:428–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Nguyen NT, Varela E, Sabio A, et al. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2006;203:24–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104:1251–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Asztalos BF, Swarbrick MM, Schaefer EJ, et al. Effects of weight loss, induced by gastric bypass surgery, on HDL remodeling in obese women. J Lipid Res. 2010;51:2405–12.PubMedGoogle Scholar
  19. 19.
    Pihlajamäki J, Grönlund S, Simonen M, et al. Cholesterol absorption decreases after Roux-en-Y gastric bypass but not after gastric banding. Metabolism. 2010;59:866–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Hubbard VS, Hall WH. National Institutes of Health Consensus Development Conference Draft statement on gastrointestinal surgery for severe obesity. Obes Surg. 1991;1:257–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160–7.CrossRefGoogle Scholar
  23. 23.
    Chobanian AV, Bakris GL, Black HR, et al. Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of preparative ultracentrifuge. Clin Chem. 1972;218:499–502.Google Scholar
  26. 26.
    Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Dixon JB, O'Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obesity. 2002;10:903–10.CrossRefGoogle Scholar
  28. 28.
    Hanusch-Enserer U, Zorn G, Wojta J, et al. Non-conventional markers of atherosclerosis before and after gastric banding surgery. Eur Heart J. 2009;30:1516–24.PubMedCrossRefGoogle Scholar
  29. 29.
    Lubrano C, Mariani S, Badiali M, et al. Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors. Int J Obes (Lond). 2010;34:1404–14.CrossRefGoogle Scholar
  30. 30.
    Knopp RH, Gitter H, Truitt T, et al. Effects of ezetimibe, a new cholesterol absorption inhibitor, on plasma lipids in patients with primary hypercholesterolemia. Eur Heart J. 2003;24:729–41.PubMedCrossRefGoogle Scholar
  31. 31.
    Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med. 1990;323:946–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Buchwald H, Rudser KD, Williams SE, et al. Overall mortality, incremental life expectancy, and cause of death at 25 years in the program on the surgical control of the hyperlipidemias. Ann Surg. 2010;251:1034–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Pohle-Krauza RJ, McCarroll ML, Pasini DD, et al. Age and gender exert differential effects on blood lipids in patients after LAGB and LRYGB. Surg Obes Relat Dis. 2011;7:170–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Sarzynski MA, Jacobson P, Rankinen T, et al. Association of GWAS-based candidate genes with HDL-cholesterol levels before and after bariatric surgery in the Swedish Obese Subjects Study. J Clin Endocrinol Metab. 2011;96:953–7.CrossRefGoogle Scholar
  35. 35.
    Sarzynski MA, Jacobson P, Rankinen T, et al. Polymorphisms in the ghrelin gene are associated with serum high-density lipoprotein cholesterol level and not with type 2 diabetes mellitus in Koreans. J Clin Endocrinol Metab. 2006;91:4657–63.CrossRefGoogle Scholar
  36. 36.
    Martin GR, Loredo JC, Sun G. Lack of association of ghrelin precursor gene variants and percentage body fat or serum lipid profiles. Obesity. 2008;16:908–12.PubMedCrossRefGoogle Scholar
  37. 37.
    Boes E, Coassin S, Kollerits B, et al. Genetic–epidemiological evidence on genes associated with HDL cholesterol levels: a systematic in-depth review. Exp Gerontol. 2009;44:136–60.PubMedCrossRefGoogle Scholar
  38. 38.
    Cheng KC, Li YX, Asakawa A, et al. The role of ghrelin in energy homeostasis and its potential clinical relevance. Int J Mol Med. 2010;26:771–8.PubMedGoogle Scholar
  39. 39.
    Brolin RE, Bradley LJ, Wilson AC, et al. Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity. J Gastrointest Surg. 2000;4:464–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • D. Benaiges
    • 1
    • 2
    Email author
  • J. A. Flores-Le-Roux
    • 1
    • 2
  • J. Pedro-Botet
    • 1
    • 2
  • J. M. Ramon
    • 2
    • 3
  • A. Parri
    • 1
  • M. Villatoro
    • 1
  • M. J. Carrera
    • 1
  • M. Pera
    • 2
    • 3
  • E. Sagarra
    • 1
  • L. Grande
    • 2
    • 3
  • A. Goday
    • 1
    • 2
  • On behalf the Obemar Group
  1. 1.Department of Endocrinology and NutritionHospital del MarBarcelonaSpain
  2. 2.Universitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Section of Gastrointestinal SurgeryHospital del MarBarcelonaSpain

Personalised recommendations