Impact of laparoscopic Roux-en-Y Gastric bypass versus sleeve gastrectomy on postoperative lipid values

Abstract

BackgroundMetabolic surgery has been shown to significantly improve many obesity-related co-morbidities, including dyslipidemia. The literature has produced mixed results comparing postoperative lipid values after laparoscopic Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and low-density lipoprotein (LDL) in LRYGB versus LSG, and others reporting no significant differences. ObjectivesTo evaluate the postoperative lipid values after LRYGB versus LSG at a community hospital. SettingIntegrated multispecialty health system with a community teaching hospital. MethodsA retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6–18 months postoperative were evaluated. Statistical analysis included χ2 and Wilcoxon rank-sum tests. A P value<.05 was considered significant. ResultsThere were 1326 and 121 patients who underwent LRYGB and LSG during the study period, respectively. Of these patients, 644 LRYGB and 67 LSG patients had pre- and postoperative lipid values available and included in the final analysis. Postoperative mean total cholesterol and LDL values were significantly lower in LYRGB versus LSG patients. Postoperatively, 10% and 30% of LRYGB and LSG patients had a total cholesterol values≥200 mg/dL (P<.001); 4% and 24% had LDL values≥130 mg/dL (P<.001); and 8% and 9% had triglyceride levels>130 mg/dL (P = .68), respectively. HDL values were within the recommended range in 52% and 57% of LRYGB and LSG patients, respectively (P = .64). ConclusionPatients who underwent LRYGB had a greater postoperative reduction in total cholesterol, LDL, and triglycerides. LRYGB may be the more appropriate bariatric procedure for patients with significant preoperative hypercholesterolemia.