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Comparative Effectiveness of Different Bariatric Procedures in Super Morbid Obesity

  • Rita Bettencourt-Silva
  • João Sérgio Neves
  • Jorge Pedro
  • Vanessa Guerreiro
  • Maria João Ferreira
  • Daniela Salazar
  • Pedro Souteiro
  • Daniela Magalhães
  • Sofia Castro Oliveira
  • Joana Queirós
  • Sandra Belo
  • Ana Varela
  • Paula Freitas
  • AMTCO Group
  • Davide Carvalho
Original Contributions
  • 75 Downloads

Abstract

Background

Super obesity (BMI ≥ 50 kg/m2) is associated with significant morbidity and mortality. The best procedure to treat super obesity is not completely established. Our aim was to compare the effectiveness of bariatric procedures (adjustable gastric band [AGB], Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]) in super obesity.

Methods

Retrospective observational study of super obese patients who underwent bariatric surgery. Data was assessed preoperatively and in the 1st and 2nd years of follow-up.

Results

We evaluated 213 individuals, 77.9% female, age of 43.38 ± 11.49 years, and preoperative BMI of 54.53 ± 4.54 kg/m2; 19 submitted to AGB, 127 to RYGB, and 67 to SG. In the pre-surgical assessment, there were no significant differences in age, anthropometric parameters, blood pressure, glycemic profile, and lipid profile between the three surgical groups. The percentage of excess weight loss (%EWL) in the 1st year was 67.58% in RYGB, 58.74% in SG, and 38.71% in AGB (p < 0.001), and the percentage of total weight loss (%TWL) was 36.29%, 31.59%, and 21.07%, respectively (p < 0.001). Two years after surgery (n = 147; follow-up rate of 69%), the %EWL and %TWL were significantly higher in the RYGB group (p < 0.001). RYGB had a higher success rate (%EWL ≥ 50% and %TWL ≥ 20%) in both years of follow-up (p < 0.001). In multiple linear regression, after adjusting for other covariates, RYGB was the only strong predictive factor of %EWL and %TWL (p < 0.001).

Conclusion

RYGB proved to be more effective in super obesity. The beneficial effects in weight loss were evident both 1 and 2 years after the procedure, regardless of pre-surgical anthropometric characteristics.

Keywords

Super morbid obesity Bariatric surgery Weight loss Gastric bypass Adjustable gastric band Sleeve gastrectomy 

Notes

Acknowledgments

We would like to acknowledge all the endocrinologists, surgeons, and nutritionists of the Multidisciplinary Group for Surgical Management of Obesity.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study 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

For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rita Bettencourt-Silva
    • 1
    • 2
    • 3
  • João Sérgio Neves
    • 1
    • 2
    • 3
    • 4
  • Jorge Pedro
    • 1
    • 2
  • Vanessa Guerreiro
    • 1
    • 2
  • Maria João Ferreira
    • 1
  • Daniela Salazar
    • 1
  • Pedro Souteiro
    • 1
    • 2
    • 3
  • Daniela Magalhães
    • 1
    • 2
    • 3
  • Sofia Castro Oliveira
    • 1
    • 2
    • 3
  • Joana Queirós
    • 1
    • 5
  • Sandra Belo
    • 1
    • 5
  • Ana Varela
    • 1
    • 2
    • 5
  • Paula Freitas
    • 1
    • 2
    • 3
    • 5
  • AMTCO Group
    • 5
  • Davide Carvalho
    • 1
    • 2
    • 3
  1. 1.Department of Endocrinology, Diabetes and MetabolismCentro Hospitalar São JoãoPortoPortugal
  2. 2.Faculty of Medicine of University of PortoPortoPortugal
  3. 3.Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
  4. 4.Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of MedicineUniversity of PortoPortoPortugal
  5. 5.Multidisciplinary Group for Surgical Management of ObesityCentro Hospitalar São JoãoPortoPortugal

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