Image: The four common types of bariatric surgery (Photo courtesy of the NIH).
A new study concludes that in the morbidly obese, there is no significant difference in excess body mass index (BMI) loss between sleeve gastrectomy and Roux-en-Y gastric bypass (RYGBP).
Researchers at University Hospital Basel (Switzerland), St. Claraspital (Basel, Switzerland), and other institutions conducted a randomized, two-group trial between January 2007 and November 2011 involving 217 patients (average age 45.5 years, 72% women) who randomly assigned to sleeve gastrectomy (107 patients) or RYGBP (110 patients) in order to compare the two procedures in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events.
The results revealed that in terms of weight loss, both laparoscopic procedures led to similar results at five-year follow-up. Patients lost 68% of their excess weight after a gastric bypass, and 61% after a sleeve gastrectomy, with BMI falling from 44 to 32 for both. Patients with existing gastric acid reflux benefited more from RYGBP, with symptoms eliminated in 60%, compared to just 25% following sleeve gastrectomy. Associated diseases such as hypertension, diabetes, back/joint pain and depression were also improved, as well as general quality of life. The study was published on January 16, 2018, in JAMA.
“We have always paid attention to gastroesophageal reflux (GERD) when advising patients as to which operation they should get, but 31.8% of the people who received the sleeve procedure saw their acid reflux symptoms increase, compared to just 6.3% of those getting the older bypass procedure,” said lead author Ralph Peterli, MD, of St Claraspital. “As a result of the study, we tell them that every third patient not suffering from GERD before surgery may end up experiencing some degree of it in the long run.”
Bariatric surgery is achieved by reducing the size of the stomach with an implanted medical device such as a gastric band (GB), through removal of a portion of the stomach via a vertical sleeve gastrectomy or through a biliopancreatic diversion with duodenal switch (BPD-DS), or by resecting and re-routing the small intestines to a small stomach pouch (RYGBP). In the United States there is a much greater increase in GB than RYGBP, probably due to the preconception that GB is a "simple and safer" procedure.
University Hospital Basel