Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up

In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32–1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46–0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53–0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43–0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55–0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.

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Cardiovascular Risk Reduction after Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass: A Match Control Study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2017.09.018 ◽

2017 ◽

Vol 13 (10) ◽

pp. S7 ◽

Cited By ~ 1

Author(s):

David Gutierrez Blanco ◽

David Romero Funes ◽

Emanuele Lo Menzo ◽

Samuel Szomstein ◽

Raul Rosenthal

Keyword(s):

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Cardiovascular Risk ◽

Laparoscopic Sleeve Gastrectomy ◽

Risk Reduction ◽

Laparoscopic Gastric Bypass ◽

Cardiovascular Risk Reduction ◽

Control Study

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2030-P: The Efficacy of Laparoscopic Sleeve Gastrectomy in Severely Obese Patients with Varying Serum Triglyceride Levels

Diabetes ◽

10.2337/db20-2030-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 2030-P

Author(s):

GUIFANG LI ◽

YUEYE HUANG ◽

JUNYI ZHANG ◽

XINGCHUN WANG ◽

CHUNHUA QIAN ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Serum Triglyceride ◽

Obese Patients ◽

Severely Obese

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P-141: Preliminary results from very restrictive laparoscopic sleeve gastrectomy in 120 patients and 18 month follow-up, in morbidly obese patients

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2010.03.185 ◽

2010 ◽

Vol 6 (3) ◽

pp. S73

Author(s):

Jose Vicente Ferrer ◽

Angel Sanahuja ◽

Jose Eduardo Perez Folques ◽

Nieves Saiz-Sapena ◽

Diana Cester

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Morbidly Obese ◽

Obese Patients ◽

Preliminary Results

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Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Obesity Facts ◽

10.1159/000512450 ◽

2020 ◽

pp. 1-10

Author(s):

Julian Bühler ◽

Silvan Rast ◽

Christoph Beglinger ◽

Ralph Peterli ◽

Thomas Peters ◽

...

Keyword(s):

Vitamin D ◽

Gastric Bypass ◽

Body Composition ◽

Sleeve Gastrectomy ◽

Bone Mass ◽

Laparoscopic Sleeve Gastrectomy ◽

Mass Density ◽

Bone Mass Density

Background: Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) are scarce. Objective: The aim of this study was to assess body composition and BMD at least 5 years after LSG and LRYGB. Setting: Department of Endocrinology and Nutrition, St. Claraspital Basel and St. Clara Research Ltd., Basel, Switzerland. Methods:Bariatric patients at least 5 years after surgery (LSG or LRYGB) were recruited, and body composition and BMD were measured by means of dual-energy X-ray absorptiometry. Data from body composition before surgery were included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone, vitamin D3, alkaline phosphatase, and C-terminal telopeptide, and the individual risk for osteoporotic fracture assessed by the Fracture Risk Assessment Tool score was calculated. After surgery, all patients received multivitamins, vitamin D3, and zinc. In addition, LRYGB patients were prescribed calcium. Results: A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median body mass index 43.1, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, the percentage total weight loss at follow-up was 26.3% and for LSG 24.1% (p = 0.243). LRYGB led to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T score at the femoral neck below –1, indicating osteopenia. No clinically relevant difference in BMD was found between the groups. Conclusions:At 6.7 years after surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.

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Ist Diabetes heilbar durch bariatrische Chirurgie? – Mechanismen der Verbesserung der diabetischen Stoffwechsellage durch chirurgische Adipositastherapie –

Diabetologie und Stoffwechsel ◽

10.1055/s-0043-119075 ◽

2017 ◽

Vol 12 (05) ◽

pp. 372-385

Author(s):

Matthias Weck

Keyword(s):

Diabetes Mellitus ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Bariatrische Chirurgie ◽

Diabetes Mellitus Typ 2 ◽

Typ 2 Diabetes ◽

Omega Loop ◽

Bariatrische Operationen

In den letzten Jahren wurden die Ergebnisse randomisierter kontrollierter Studien publiziert, die im 5-Jahres-Verlauf die metabolischen Effekte der bariatrischen Chirurgie mit konventionellen Formen der Gewichtsreduktion vergleichen. Diese Studien zeigen unisono, dass die bariatrische Chirurgie hinsichtlich der Besserung der diabetischen Stoffwechsellage den konventionellen Behandlungsformen signifikant überlegen ist. Die Diabetesremissionsraten variieren abhängig von Ausgangsparametern, Operationsmethode und Follow-up-Dauer zwischen 95 und 23 %.Ist Diabetes heilbar durch bariatrische Chirurgie? Die klare Antwort muss lauten: Nein, aberInsofern ist die bariatrische Chirurgie in Form von Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) und den neueren Verfahren wie Omega Loop Bypass („Mini-Bypass“) oder biliopankreatische Diversion (BPD) eine wirkungsvolle therapeutische Option in der Behandlung des Diabetes mellitus Typ 2 und verringert offenbar auch das Risiko des Auftretens von mikrovaskulären Diabetesfolgekomplikationen. Je früher im Krankheitsverlauf die bariatrische Chirurgie SSherangezogen wird, desto effektiver scheinen diese Verfahren zu sein.Welche der Operationen für Patienten mit Typ-2-Diabetes am besten geeignet ist, ist derzeit nicht definitiv entschieden. Der RYGB scheint etwas effektiver zu sein. Die Verfahren der bariatrischen Chirurgie gehören in das Spektrum der differenzialtherapeutischen Überlegungen insbesondere bei adipösen Patienten mit Typ-2-Diabetes mit einem BMI > 35 kg/m².Die Mechanismen der Verbesserung der diabetischen Stoffwechsellage durch bariatrische Operationen werden anhand der aktuellen Literatur detailliert beschrieben. Die Indikationen, Kontraindikationen, Komplikationen und Therapiealgorithmen der bariatrischen Chirurgie bei Typ-2-Diabetes sind in den entsprechenden Leitlinien ausführlich dargestellt und nicht Gegenstand dieser Publikation.

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