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Clinical Outcomes of Resectional Roux-en-Y Gastric Bypass, Compared to Sleeve Gastrectomy for Severe Obesity

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Abstract

Purpose

Resectional Roux-en-Y gastric bypass (RRYGB) is considered an alternative bariatric surgery in countries with a high incidence of stomach cancer because there is no excluded stomach after RRYGB. This study aimed to evaluate the efficacy and safety of RRYGB.

Materials and Methods

This study included patients who underwent RRYGB and sleeve gastrectomy (SG) between 2011 and 2021. Surgical complications and metabolic and nutritional profiles were compared between the patients preoperatively and at 1, 6, and 12 months after surgery.

Results

Twenty and seventy-six patients underwent RRYGB and SG, respectively; 7 in the SG group were lost to follow-up within 1 year. Surgical complications and baseline characteristics were comparable between two groups, except for diabetes (90.0% vs. 44.7%, p < 0.001). The decrease of HbA1c levels and incidence of reflux esophagitis were lower in the RRYGB group compared to that of SG at 1-year postoperative (-3.0% vs. -1.8%, p = 0.014; 0% vs. 26.7%, p = 0.027). The percentage of total weight loss at 1- year postoperative and incidence of dumping syndrome were comparable between the two groups. The RRYGB group had significantly lower total cholesterol level (161.9 mg/dl vs. 196.4 mg/dl, p < 0.001), but higher incidence of vitamin B12 deficiency (30.0% vs. 3.6%, p = 0.003) at 1 year postoperative compared to those of the SG group.

Conclusions

The RRYGB group had better postoperative outcomes for diabetes and dyslipidemia without increasing surgical complications compared to that of the SG group. Thus, RRYGB can be considered a safe and effective alternative in areas where gastric cancer is prevalent.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Park DJ, An S, Park YS, et al. Bariatric surgery versus medical therapy in Korean obese patients: prospective multicenter nonrandomized controlled trial (KOBESS trial). Ann Surg Treat Res. 2021;101(4):197–205.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Oh TJ, Lee HJ, Cho YM. East Asian perspectives in metabolic and bariatric surgery. J Diabetes Investig. 2022;13(5):756–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    Article  CAS  PubMed  Google Scholar 

  4. Park SH, Kang MJ, Yun EH, et al. Epidemiology of gastric cancer in Korea: trends in incidence and survival based on korea central cancer registry data (1999–2019). J Gastric Cancer. 2022;22(3):160–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–75.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Elton E, Hanson BL, Qaseem T, et al. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47(1):62–7.

    Article  CAS  PubMed  Google Scholar 

  7. Silecchia G, Catalano C, Gentileschi P, et al. Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2002;12(1):39–48.

    Article  PubMed  Google Scholar 

  8. Curry TK, Carter PL, Porter CA, et al. Resectional gastric bypass is a new alternative in morbid obesity. Am J Surg. 1998;175(5):367–70.

    Article  CAS  PubMed  Google Scholar 

  9. Park JY, Kim YJ. Laparoscopic resectional gastric bypass: initial experience in morbidly obese Korean patients. Surg Today. 2015;45(8):1032–9.

    Article  PubMed  Google Scholar 

  10. Parrott J, Frank L, Rabena R, et al. American society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.

    Article  PubMed  Google Scholar 

  11. Leahy CR, Luning A. Review of nutritional guidelines for patients undergoing bariatric surgery. AORN J. 2015;102(2):153–60.

    Article  PubMed  Google Scholar 

  12. Grong E, Arbo IB, Thu OK, et al. The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats. Surg Endosc. 2015;29(3):723–33.

    Article  PubMed  Google Scholar 

  13. Sillakivi T, Suumann J, Kirsimagi U, et al. Plasma levels of gastric biomarkers in patients after bariatric surgery: biomarkers after bariatric surgery. Hepatogastroenterology. 2013;60(128):2129–32.

    PubMed  Google Scholar 

  14. Lee KG, Lee HJ, Yang JY, et al. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien-Dindo system. J Gastrointest Surg. 2014;18(7):1269–77.

    Article  PubMed  Google Scholar 

  15. Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84.

    Article  PubMed  Google Scholar 

  16. Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650–7.

    Article  PubMed  Google Scholar 

  17. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hong S, Won YJ, Lee JJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat. 2021;53(2):301–15.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kang SH, Lee Y, Park YS, et al. Solo single-incision laparoscopic resectional Roux-en-Y gastric bypass for morbid obesity with metabolic syndrome. Obes Surg. 2017;27(12):3314–9.

    Article  PubMed  Google Scholar 

  20. Kumar SB, Hamilton BC, Wood SG, et al. Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis. 2018;14(3):264–9.

    Article  PubMed  Google Scholar 

  21. Surve A, Cottam D, Richards C, et al. A matched cohort comparison of long-term outcomes of Roux-en-Y gastric bypass (RYGB) versus Single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Obes Surg. 2021;31(4):1438–48.

    Article  PubMed  Google Scholar 

  22. Wiggins T, Pournaras DJ, Priestman E, et al. Effect of preoperative weight loss and baseline comorbidity on short-term complications and reoperations after laparoscopic Roux-en-Y gastric bypass in 2,067 patients. Obes Surg. 2021;31(6):2444–52.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Cowan GS Jr, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg. 1998;22(9):987–92.

    Article  PubMed  Google Scholar 

  25. 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(5):464–9.

    Article  CAS  PubMed  Google Scholar 

  26. Lewis CA, de Jersey S, Seymour M, et al. Iron, vitamin B12, folate and copper deficiency after bariatric surgery and the impact on anaemia: a systematic review. Obes Surg. 2020;30(11):4542–91.

    Article  PubMed  Google Scholar 

  27. Yale CE, Gohdes PN, Schilling RF. Cobalamin absorption and hematologic status after two types of gastric surgery for obesity. Am J Hematol. 1993;42(1):63–6.

    Article  CAS  PubMed  Google Scholar 

  28. Ahmad A, Kornrich DB, Krasner H, et al. Prevalence of dumping syndrome after laparoscopic sleeve gastrectomy and comparison with laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2019;29(5):1506–13.

    Article  PubMed  Google Scholar 

  29. Lewis KH, Arterburn DE, Zhang F, et al. Comparative effectiveness of vertical sleeve gastrectomy versus Roux-en-Y gastric bypass for diabetes treatment: a claims-based cohort study. Ann Surg. 2021;273(5):940–8.

    Article  PubMed  Google Scholar 

  30. Huh YJ, Son YG, Kim TH, et al. Effect and mechanisms of diabetes resolution according to the range of gastric resection and the length of anastomosis in animal models: implication for gastric cancer surgery in patients with diabetes mellitus. World J Surg. 2018;42(4):1056–64.

    Article  PubMed  Google Scholar 

  31. Hofso D, Fatima F, Borgeraas H, et al. Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(12):912–24.

    Article  PubMed  Google Scholar 

  32. Ha J, Jang M, Kwon Y, et al. Metabolomic Profiles Predict Diabetes Remission after Bariatric Surgery. J Clin Med. 2020;9(12):3897

  33. Jun JK, Choi KS, Lee HY, et al. Effectiveness of the Korean national cancer screening program in reducing gastric cancer mortality. Gastroenterology. 2017;152(6):1319-28 e7.

    Article  PubMed  Google Scholar 

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Funding

This study was supported by grants from National Evidence-based Healthcare Collaborating Agency (grant number: HC21C0099) funded by the Ministry of Health & Welfare, Republic of Korea. The funder had no role in study design, data collection, analysis and interpretation or manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Yo-Seok Cho, Ji-Hyeon Park, JeeSun Kim, Sa-Hong Kim, Min Kyu Kang, Yeon-Ju Huh, Yun-Suhk Suh, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang & Hyuk-Joon Lee

  2. Department of Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Ji-Hyeon Park

  3. Office of Medical Education, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Yeon-Ju Huh

  4. Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-guGyeonggi-do, Seongnam-si, 13620, Republic of Korea

    Yun-Suhk Suh

  5. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang & Hyuk-Joon Lee

  6. Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Minseon Park

  7. Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Young Min Cho

  8. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Hyuk-Joon Lee

Authors
  1. Yo-Seok Cho
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  2. Ji-Hyeon Park
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  3. JeeSun Kim
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  7. Yun-Suhk Suh
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  12. Young Min Cho
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  13. Hyuk-Joon Lee
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Corresponding author

Correspondence to Hyuk-Joon Lee.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Cho, YS., Park, JH., Kim, J. et al. Clinical Outcomes of Resectional Roux-en-Y Gastric Bypass, Compared to Sleeve Gastrectomy for Severe Obesity. OBES SURG 33, 1338–1346 (2023). https://doi.org/10.1007/s11695-023-06544-z

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  • DOI: https://doi.org/10.1007/s11695-023-06544-z

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