Weight loss and effect on co-morbidities in the long-term after duodenal switch and gastric bypass: a population-based cohort study

Abstract Background When performing a Roux-en-Y gastric bypass (RYGB), the gastroenterostomy can be constructed with a circular stapled or linear stapled technique. The size of the gastroenterostomy depends on the stapling method and this may affect weight loss outcomes. The aim of this study was to examine the impact of the stapling technique on weight loss outcomes after RYGB. Methods This is a nationwide population-based cohort study of patients that received a RYGB. Data were derived from the Dutch Audit of Treatment of Obesity. Primary outcome was the impact of stapling technique on the rate of non-response defined as significant weight regain (≥20% of a patients’ lost weight) 2–4 years post-surgery, after initial successful weight loss (≥20% total weight loss, TWL). Secondary outcomes were the rate of response, defined as successful weight loss (≥20% TWL) within 1.5 years post-surgery, the incidence of complications and the progression of comorbidities. Results In a cohort of 12,468 patients, non-response was equally distributed between both groups (circular 18.0% vs. linear 17.6%). No differences in response rate (circular 97.0% vs. linear 96.5%) or %TWL were observed up to 4 years post-surgery. Patients in the circular stapled group experienced more complications, specifically major bleedings (2.4% vs. 1.2%; p=0.002) within 30 days postoperatively. No differences were found in deteriorated comorbidities, neither in de novo developed comorbidities. Conclusion When comparing stapling technique in RYGB, weight loss outcomes did not differ during a 4-year follow-up period. The linear stapled gastroenterostomy could pose an advantage due to its lower complication rate. Graphical abstract

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Long-term adverse events after sleeve gastrectomy or gastric bypass: a 7-year nationwide, observational, population-based, cohort study

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(19)30191-3 ◽

2019 ◽

Vol 7 (10) ◽

pp. 786-795 ◽

Cited By ~ 18

Author(s):

Jérémie Thereaux ◽

Thomas Lesuffleur ◽

Sébastien Czernichow ◽

Arnaud Basdevant ◽

Simon Msika ◽

...

Keyword(s):

Gastric Bypass ◽

Cohort Study ◽

Sleeve Gastrectomy ◽

Adverse Events ◽

Population Based

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Key Time Points After Bariatric Surgery, From Weight Loss To Weight Regain: Long-Term Retrospective Cohort Study

10.21203/rs.3.rs-1064596/v1 ◽

2021 ◽

Author(s):

Mahsa Hatami ◽

Abdolreza Pazouki ◽

Fatemeh Sadat Hosseini-Baharanchi ◽

Ali Kabir

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Weight Regain ◽

Long Term Results ◽

Time Points

Abstract Background and Objective: Bariatric surgery may lead to an unsuccessful weight loss, weight loss plateau, and even weight regain in different time points after various types of surgery. Despite the numerous studies investigated bariatric surgery-induced weight loss, the long-term results of surgery, after repetitive weight fluctuations, is not really clear and remains as one of the most important concerns. The aim of the present study was to determine the key time points of weight changes after three types of bariatric surgery, and the estimation of five-year weight loss after surgery. Setting: This is a retrospective cohort study including patients with morbid obesity conducted in the obesity clinic of Minimally Invasive Surgery Research Center of Iran University of Medical Sciences. Methods The subjects underwent one of the three types of bariatric surgeries including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) which had been followed up to five years after surgery. The percentage lost to follow-up was 34% until five-year after surgery. Results The mean %EWL a total of 2567 morbid obese participants (mean age=39.03, mean BMI=45.67) in the first six months after surgery was independent of the type of surgery. Ninth and 24th month after surgery were the times that OAGB and then RYGB induced weight loss sped up rather than LSG, respectively. Weight plateau and weight regain were initiated earlier (at 18th month) and more (18.23% of maximum EWL %) in LSG in the period of five years. The %EWL in time intervals of 3-6, 6-9, and 9-12 months after LSG, RYGB, and OAGB, respectively; could estimate the long-term five years %EWL after surgery. Conclusion OAGB provides the fastest and highest %EWL, and LSG induced the earliest and most weight plateau and weight regain during five years interval post-surgery. The pattern of early weight loss could predict the long-term outcome of bariatric surgery. So early identification of suboptimal weight loss could allow consideration of earlier postoperative intervention to enhance long-term weight loss.

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