Original article
Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy

https://doi.org/10.1016/j.soard.2016.01.020Get rights and content

Abstract

Background

Bariatric surgery is associated with improved co-morbidities, quality of life, and survival in severely obese patients. Common bariatric surgery procedures include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and sleeve gastrectomy (SG). Currently, literature studying comparative effectiveness on different bariatric surgery procedures in veterans is limited.

Objectives

To compare effectiveness of 3 bariatric surgery procedures performed in veterans.

Setting

Veterans Affairs Loma Linda Healthcare Systems (VALLHS), Loma Linda, California, United States.

Methods

This study was a single-institution, retrospective cohort study. Primary outcome was weight reduction, expressed as kilograms lost, body mass index (BMI) reduction, percentage weight loss (%WL), and percentage excess weight loss (%EWL) after 12 months of bariatric surgery. Secondary outcomes were reduction in number of medications and laboratory markers for obesity-related chronic conditions. Inverse-probability weighting propensity score method was used to balance baseline characteristics among the procedures.

Results

A total of 162 patients were included in the study. At 12 months, the kilograms lost, BMI reduction, %WL, and %EWL were 40.7±14.5 kg, 13.4±4.1 kg/m2, 31.5±8.5%, and 41.4±11.6% for RYGB; 24.4±22.1 kg, 7.9±7.3 kg/m2, 20.2±21.5%, and 26.7±27.6% for SG; and 15.3±15.7 kg, 5.0±5.0 kg/m2, 12.0±11.7%, and 16.1±15.9% for LAGB, respectively (RYGB versus SG, RYGB versus LAGB, and SG versus LAGB, all P<.01). The reduction in number of medications, total cholesterol, and low-density lipoprotein (LDL) also showed significant improvement with RYGB.

Conclusion

For the short term, RYGB appears to achieve better weight reduction and management of obesity-associated co-morbid conditions compared with the SG and LAGB procedures in veteran patients. SG could be the next alternative over LAGB for the bariatric surgery procedure in patients who are not candidates for RYGB.

Section snippets

Materials and methods

This study was a single-institution, retrospective cohort study at a Veterans Affairs (VA) medical center with specialty in bariatric surgery. Data collection was carried out by utilizing the VA Computerized Patient Record System. The Institutional Review Board (IRB) committees from the VA medical center as well as our institution have approved the study.

Baseline characteristics

A total of 336 veteran patients were initially screened, of which 174 patients were excluded (120 patients did not receive bariatric surgery and 54 patients underwent surgery outside the VA medical center). This left 162 patients to be included in the study. There were 84 patients who underwent the RYGB procedure, 48 patients received SG, and 30 patients had LAGB. Regarding the surgical technique, laparoscopic method was the primary technique performed in all 3 bariatric procedures (RYGB: 96.4%

Discussion

With the increased prevalence of obesity and its associated co-morbid medical conditions, the number of bariatric surgeries performed in the United States was up>50% within 2 years between 2011 and 2013 [28]. Even with its increasing popularity, comparative effectiveness evidence among the most common bariatric surgery procedures in the United States, especially in the veteran population, is limited. In the present study, we investigated the short-term outcomes of weight loss and

Conclusion

In the veteran population, the RYGB procedure appears to achieve better short-term outcomes in terms of weight reduction and management of obesity-associated co-morbid conditions compared with the SG and LAGB procedures. SG may be the next best option for bariatric surgery in patients who are not candidates for RYGB.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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  • Cited by (0)

    Presented in part at American Society for Metabolic and Bariatric Surgery (ASMBS) Obesity Week in Los Angeles, California, November 4–6, 2015.

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