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Obesity Surgery

Erschienen in:

11.01.2019 | Original Contributions

Short-Term Outcomes of Sleeve Gastrectomy plus Jejunojejunal Bypass: a Retrospective Comparative Study with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Chinese Patients with BMI ≥ 35 kg/m²

verfasst von: Shibo Lin, Wei Guan, Ningli Yang, Yan Zang, Ruiping Liu, Hui Liang

Erschienen in: Obesity Surgery | Ausgabe 4/2019

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Abstract

Background

Bariatric surgery represents the most effective treatment for obesity and its related comorbidities. The present study aims to evaluate the efficacy and safety of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB).

Methods

This retrospective study included 244 obese patients with BMI ≥ 35 kg/m² undergoing SG + JJB (n = 83), SG (n = 82), and Roux-en-Y gastric bypass (RYGB) (n = 79). Postoperative weight loss, metabolic outcomes, nutrition status, and patients’ complaints at 1-year follow-up were compared. Subgroup analyses (36 pairs of SG + JJB/SG and 37 pairs of SG + JJB/RYGB) were performed to compare weight loss and lipid profiles after matching with gender, age, and BMI.

Results

In subgroup case-matched study, SG + JJB exhibited superior weight loss effect to SG regarding total weight loss (38.8 ± 8.7% vs 35.0 ± 6.1%, P = 0.011) and excessive weight loss (95.3 ± 20.4% vs 86.9 ± 13.7%, P = 0.033) at 1-year follow-up. The postoperative metabolic outcomes, nutritional status, and patients’ complaints were similar between SG + JJB and SG. SG + JJB yielded similar weight loss, T2DM remission, and hypertension resolution to RYGB at 1-year follow-up, but less postoperative complications than RYGB regarding anemia (4.8% vs 22.8%), vitamin D deficiency (47.0% vs 65.8%), vitamin B12 deficiency (8.4% vs 25.3%), hypoalbuminemia (1.2% vs 8.9%), diarrhea (6.0% vs 21.5%), dumping syndrome (0 vs 7.6%), and fatigue (25.3% vs 40.5%) (P < 0.05). In subgroup case-matched study, RYGB improved total cholesterol and low-density lipoprotein better than SG + JJB (P < 0.05).

Conclusions

In short-term follow-up, SG + JJB offered better weight loss than SG and similar weight loss to RYGB. SG + JJB resulted in less postoperative nutritional deficiency and complications than RYGB except for lipid and hypertension improvement.

Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. https://doi.org/10.1136/bmj.f5934.CrossRefPubMedPubMedCentral

Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. https://doi.org/10.1056/NEJMoa066254.CrossRefPubMed

Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89. https://doi.org/10.1007/s11695-017-2666-x.CrossRefPubMedPubMedCentral

Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11):4331–45. https://doi.org/10.1007/s00464-017-5505-1.CrossRefPubMed

Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine. 2017;96(46):e8632. https://doi.org/10.1097/MD.0000000000008632.CrossRefPubMedPubMedCentral

Dogan K, Homan J, Aarts EO, et al. Long-term nutritional status in patients following roux-en-Y gastric bypass surgery. Clin Nutr. 2018;37(2):612–7. https://doi.org/10.1016/j.clnu.2017.01.022.CrossRefPubMed

Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surg Obes Relat Dis. 2016;12(1):11–20. https://doi.org/10.1016/j.soard.2015.04.011.CrossRefPubMed

Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73. https://doi.org/10.1097/SLA.0b013e3182263b66.CrossRefPubMed

Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18(10):1287–96. https://doi.org/10.1007/s11695-008-9456-4.CrossRefPubMed

10.

Hans PK, Guan W, Lin S, et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg. 2017;41:285–90. https://doi.org/10.1016/j.asjsur.2017.04.003.CrossRefPubMed

11.

Meany G, Conceicao E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev. 2014;22(2):87–91. https://doi.org/10.1002/erv.2273.CrossRefPubMedPubMedCentral

12.

Lee WJ, Lee KT, Kasama K, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass. Obes Surg. 2014;24(1):109–13. https://doi.org/10.1007/s11695-013-1067-z.CrossRefPubMed

13.

Lee WJ, Almulaifi AM, Tsou JJ, et al. Duodenal-jejunal bypass with sleeve gastrectomy versus the sleeve gastrectomy procedure alone: the role of duodenal exclusion. Surg Obes Relat Dis. 2015;11(4):765–70. https://doi.org/10.1016/j.soard.2014.12.017.CrossRefPubMed

14.

Alamo M, Sepulveda M, Gellona J, et al. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patients with body mass index <35 kg/m². A cohort study. Obes Surg. 2012;22(7):1097–103. https://doi.org/10.1007/s11695-012-0652-x.CrossRefPubMed

15.

Sepulveda M, Alamo M, Preiss Y, et al. Metabolic surgery comparing sleeve gastrectomy with Jejunal bypass and Roux-en-Y gastric bypass in type 2 diabetic patients after 3 years. Obes Surg. 2018;28(11):3466–73. https://doi.org/10.1007/s11695-018-3402-x.CrossRefPubMed

16.

Lin S, Guan W, Hans P, et al. Status of laparoscopic sleeve gastrectomy in China: a national survey. Obes Surg. 2017;27(11):2968–73. https://doi.org/10.1007/s11695-017-2727-1.CrossRefPubMed

17.

Berger AM, Mooney K, Alvarez-Perez A, et al. Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw. 2015;13(8):1012–39.CrossRef

18.

Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. https://doi.org/10.2337/dc16-0236.CrossRefPubMed

19.

Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes. 2011;35(Suppl 3):S45–9. https://doi.org/10.1038/ijo.2011.148.CrossRef

20.

Halverson JD, Scheff RJ, Gentry K, et al. Long-term follow-up of jejunoileal bypass patients. Am J Clin Nutr. 1980;33(2 Suppl):472–5. https://doi.org/10.1093/ajcn/33.2.472.CrossRefPubMed

21.

Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239(1):1–11. https://doi.org/10.1097/01.sla.0000102989.54824.fc.CrossRefPubMedPubMedCentral

22.

Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56. https://doi.org/10.1038/nrendo.2012.48.CrossRefPubMed

23.

Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004;89(6):2595–600. https://doi.org/10.1210/jc.2004-0372.CrossRefPubMed

24.

Praveen Raj P, Bhattacharya S, Saravana Kumar S, et al. Comparison of effects of sleeve gastrectomy and gastric bypass on lipid profile parameters in Indian obese: a case matched analysis. Obes Surg. 2017;27(10):2606–12. https://doi.org/10.1007/s11695-017-2692-8.CrossRefPubMed

25.

Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54. https://doi.org/10.1001/jama.2017.20313.CrossRefPubMedPubMedCentral

26.

Melissas J, Stavroulakis K, Tzikoulis V, et al. Sleeve gastrectomy vs Roux-en-Y gastric bypass. Data from IFSO-European chapter Center of Excellence Program. Obes Surg. 2017;27(4):847–55. https://doi.org/10.1007/s11695-016-2395-6.CrossRefPubMed

27.

Powell-Jackson PR, Maudgal DP, Sharp D, et al. Intestinal bacterial metabolism of protein and bile acids: role in pathogenesis of hepatic disease after jejuno-ileal bypass surgery. Br J Surg. 1979;66(11):772–5.CrossRefPubMed

28.

Ogata Y, Nishi M, Nakayama H, et al. Role of bile in intestinal barrier function and its inhibitory effect on bacterial translocation in obstructive jaundice in rats. J Surg Res. 2003;115(1):18–23.CrossRefPubMed

29.

Ishida RK, Faintuch J, Ribeiro AS, et al. Asymptomatic gastric bacterial overgrowth after bariatric surgery: are long-term metabolic consequences possible? Obes Surg. 2014;24(11):1856–61. https://doi.org/10.1007/s11695-014-1277-z.CrossRefPubMed

30.

Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605. https://doi.org/10.1007/s11695-016-2343-5.CrossRefPubMed

31.

Wolvekamp MC, Heineman E, Taylor RG, et al. Towards understanding the process of intestinal adaptation. Dig Dis. 1996;14(1):59–72. https://doi.org/10.1159/000171539.CrossRefPubMed

32.

Hassn A, Luhmann A, Rahmani S, et al. Medium-term results of combined laparoscopic sleeve gastrectomy and modified Jejuno-Ileal bypass in bariatric surgery. Obes Surg. 2016;26(10):2316–23. https://doi.org/10.1007/s11695-016-2098-z.CrossRefPubMed

33.

Vidal P, Ramon JM, Goday A, et al. Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg. 2014;24(2):179–83. https://doi.org/10.1007/s11695-013-1094-9.CrossRefPubMed

Titel: Short-Term Outcomes of Sleeve Gastrectomy plus Jejunojejunal Bypass: a Retrospective Comparative Study with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Chinese Patients with BMI ≥ 35 kg/m2
verfasst von: Shibo Lin
Wei Guan
Ningli Yang
Yan Zang
Ruiping Liu
Hui Liang
Publikationsdatum: 11.01.2019
Verlag: Springer US
Erschienen in: Obesity Surgery / Ausgabe 4/2019
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-03688-1

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Abstract

Background

Methods

Results

Conclusions

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