Abstract
AimsBariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study.MethodsWe analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL−R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital.ResultsIn a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL−R; with RYGB and SG both BMI and FM slightly increased in the years 3–5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL−R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered.ConclusionsAll surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3–5, while BPD and BPD + LCL−R showed a slight further decreases in the same time interval.
Highlights
Bariatric surgeries have increased progressively during the last 25 years, and currently, Italy stands among the five leading countries for number of procedures performed in the last 5 years [1]
BMI was calculated as weight/square height [kg/m2]; body composition was measured by body impedance analysis (BIA), through a 8 electrodes Tanita BC 418 (Tanita Impedance Balance, Tokyo, Japan) to assess fat mass (FM, kg and as percentage), fat-free mass (FFM, kg and as percentage) and total body water (TBW, absolute and percentage)
Surgical techniques (BPD and biliopancreatic diversion (BPD) + LCL−R) have been parallel, but BPD + LCL−R showed a further decrease at 5 years, reaching values of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) at the end of the observation period (Fig. 5a)
Summary
Bariatric surgeries have increased progressively during the last 25 years, and currently, Italy stands among the five leading countries for number of procedures performed in the last 5 years [1]. The abdominal visceral fat excess plays a significant role because induces and maintains lipotoxicity and insulin resistance with increased risk of macrovascular complications [13, 14] In these subjects, it is difficult/ impossible to achieve a significant and lasting weight loss through medical treatment [15]. A constellation of factors is likely responsible for the improvement or resolution of DM2 following metabolic surgery Among these are noteworthy the enhancement of the neural signalling, the changes in gut hormones release (GLP1 and GIP), the modulation of the intestinal microbioma and bile composition and the acute reduction of glucoxicity/lipotoxicity [18, 19]. The aim of this study was to compare longitudinally the effect of BPD, RYGB, SG and BPD + LCL−R on %EBL and body composition for 5 years post-surgery in subjects operated in the same Institution
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