Abstract
BackgroundAlthough laparoscopic sleeve gastrectomy (LSG) was initially described as the first step of a 2-stage procedure for high-risk patients requiring laparoscopic Roux-en-Y gastric bypass (LRYGB), it is now being used as a single-stage procedure. Experience with laparoscopic bariatric surgery is growing, such that LRYGB is increasingly feasible for patients with body mass index (BMI)≥50 kg/m². Nevertheless, outcomes for such category of patients following LSG and LRYGB are lacking. Objective: To compare weight loss and changes in obesity related co-morbidities at one year following LSG with LRYGB in patients with BMI≥50 kg/m². Settings: The prospective database of a single surgery university center was queried for clinical and other relevant data. MethodsFrom January 2004 to January 2013, 74 and 285 patients underwent LSG or LRYGB with a BMI≥50 kg/m². At one year, rate of follow-up was 92.8%. Success of surgery was defined as % of excess weight loss (%EWL)≥50% at one year. Logistic regression was used to compute odds ratio (OR) to evaluate the success at one year of surgery. ResultsLSG (N = 74) and LGBP (N = 285) groups did not differ for initial BMI (57.2±7.1 versus 56.7±5.5 kg/m²; P = .52), % of female (64.6% versus 73.7%, P = .13) or major adverse postoperative events (5.7% versus 6.7%; P = .85). At one year, the mean percentage of weight loss (%) (22.0±7.6 versus 30.3±7.4; P<.0001) and percentage of excess weight loss (%) (40.2±15.2 versus 55.0±14.6; P<.0001) and rates of remission of diabetes (47.5% versus 70.7%; P = .01) were greater in the LGBP than LSG group. In multivariate analyses (OR), LSG was an independent factor of failure of weight loss (.12; P< .0001) ConclusionAfter 1 year of follow-up in patients with a BMI≥50 kg/m², LRYGB provides better weight loss and resolution in diabetes than LSG with similar postoperative morbidity. Further long-term studies are needed to confirm these results.
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