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