Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI >= 50 kg/m(2)

作者：Thereaux Jeremie; Corigliano Nicola; Poitou Christine; Oppert Jean Michel; Czernichow Sebastien; Bouillot Jean Luc^*

来源：Surgery for Obesity and Related Diseases, 2015, 11(4): 785-790.

DOI：10.1016/j.soard.2014.11.022

• Bariatric surgery
• Gastric bypass
• Sleeve gastrectomy
• Super obesity
• Super-super obesity

Background: Although 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/m(2). Nevertheless, outcomes for such category of patients following LSG and LRYGB are lacking. Objective: To compare weight loss and changes in obesity related comorbidities at one year following LSG with LRYGB in patients with BMI >= 50 kg/m(2). Settings: The prospective database of a single surgery university center was queried for clinical and other relevant data.
Methods: From January 2004 to January 2013, 74 and 285 patients underwent LSG or LRYGB with a BMI >= 50 kg/m(2). 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. Results: LSG (N = 74) and LGBP (N = 285) groups did not differ for initial BMI (57.2 +/- 7.1 versus 56.7 +/- 5.5 kg/m(2); 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)
Conclusion: After 1 year of follow-up in patients with a BMI >= 50 kg/m(2), 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.

• 出版日期2015-8