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Surgical Endoscopy

Published in:

01-06-2012

Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery

Authors: Emilio Ortega, Rosa Morínigo, Lilliam Flores, Violeta Moize, Martin Rios, Antonio M. Lacy, Josep Vidal

Published in: Surgical Endoscopy | Issue 6/2012

Abstract

Background

Bariatric surgery (BS) is widely accepted for the treatment of patients with morbid obesity (MO). We aimed to determine presurgical predictors of and surgical technique-related differences in excess weight loss (EWL) 1 year after BS.

Methods

This retrospective study included 407 subjects (F/M 3:1, median age = 44 years) who underwent laparoscopic Roux-en-Y gastric bypass (RYGB, n = 307) or sleeve gastrectomy (SG, n = 100) at our University Hospital and were evaluated 1 year after surgery.

Results

Baseline median (min–max) body mass index (BMI) was 47 kg/m² (range = 36–71). BMI was higher in the SG than in the RYGB group (53 vs. 46 kg/m², p < 0.0001). Simple correlation analysis showed negative associations between EWL and age, BMI, waist circumference (WC), fasting glucose, HbA1c, triglycerides (TG), blood pressure, and total cholesterol (all p < 0.01). EWL (mean ± SD) did not differ by gender (p = 0.2), was lower in diabetic than in nondiabetic subjects (71 ± 17% vs. 79 ± 17%, p < 0.0001), and higher in the RYGB vs. SG group (76 ± 18% vs. 68 ± 15%, p < 0.0001). However, SG vs. RYGB differences in EWL disappeared (p = 0.4) after taking into account baseline BMI. Multiple regression and logistic analysis showed that younger individuals with lower BMI but higher WC, and lower HbA1c and TG, had higher EWL and a higher rate of successful (EWL ≥ 60%) weight loss.

Conclusions

Our data indicate that some of the characteristics that would have subjects referred early for BS were associated with higher weight loss. Therefore, the timing of laparoscopic BS might be an important factor for MO individuals in which medical weight loss intervention has failed.

Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, Basso N (2010) Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc 24:1005–1010PubMedCrossRef

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256PubMedCrossRef

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737PubMedCrossRef

Buchwald H, Oien DM (2009) Metabolic/bariatric surgery worldwide 2008. Obes Surg 19:1605–1611PubMedCrossRef

Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD (2009) The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis 5:476–485PubMedCrossRef

Santry HP, Gillen DL, Lauderdale DS (2005) Trends in bariatric surgical procedures. JAMA 294:1909–1917PubMedCrossRef

Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 13:861–864PubMedCrossRef

Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, Gfrerer L, Ludvik B, Zacherl J, Prager G (2010) Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 20:535–540PubMedCrossRef

Colquitt JL, Picot J, Loveman E, Clegg AJ (2009) Surgery for obesity. Cochrane Database Syst Rev (2):CD003641

10.

Jacobs M, Bisland W, Gomez E, Plasencia G, Mederos R, Celaya C, Fogel R (2010) Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc 24:781–785PubMedCrossRef

11.

Lakdawala MA, Bhasker A, Mulchandani D, Goel S, Jain S (2010) Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg 20:1–6PubMedCrossRef

12.

Menenakos E, Stamou M, Albanopoulos K, Papailiou J, Theodorou D, Leandros E (2010) Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 20:276–282PubMedCrossRef

13.

Sabbagh C, Verhaeghe P, Dhahri A, Brehant O, Fuks D, Badaoui R, Regimbeau JM (2010) Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding. Obes Surg 20:679–684PubMedCrossRef

14.

Shi X, Karmali S, Sharma AM, Birch DW (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20(8):1171–1177PubMedCrossRef

15.

Sturm R (2007) Increases in morbid obesity in the USA: 2000–2005. Public Health 121:492–496PubMedCrossRef

16.

Steinbrook R (2004) Surgery for severe obesity. N Engl J Med 350:1075–1079PubMedCrossRef

17.

Melton GB, Steele KE, Schweitzer MA, Lidor AO, Magnuson TH (2008) Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg 12:250–255PubMedCrossRef

18.

Sugerman HJ, Kellum JM, Engle KM, Wolfe L, Starkey JV, Birkenhauer R, Fletcher P, Sawyer MJ (1992) Gastric bypass for treating severe obesity. Am J Clin Nutr 55:560S–566SPubMed

19.

Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10:233–239PubMedCrossRef

20.

Yale CE (1989) Gastric surgery for morbid obesity. Complications and long-term weight control. Arch Surg 124:941–946PubMedCrossRef

21.

Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LM (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752PubMedCrossRef

22.

Vidal J, Ibarzabal A, Nicolau J, Vidov M, Delgado S, Martinez G, Balust J, Morinigo R, Lacy A (2007) Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg 17:1069–1074PubMedCrossRef

23.

Morinigo R, Casamitjana R, Moize V, Lacy AM, Delgado S, Gomis R, Vidal J (2004) Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res 12:1108–1116PubMedCrossRef

24.

Garb J, Welch G, Zagarins S, Kuhn J, Romanelli J (2009) Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg 19:1447–1455PubMedCrossRef

25.

Gehrer S, Kern B, Peters T, Christoffel-Court C, Peterli R (2010) Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg 20:447–453PubMedCrossRef

26.

Lee YC, Lee WJ, Lee TS, Lin YC, Wang W, Liew PL, Huang MT, Chien CW (2007) Prediction of successful weight reduction after bariatric surgery by data mining technologies. Obes Surg 17:1235–1241PubMedCrossRef

27.

Bueter M, Thalheimer A, Lager C, Schowalter M, Illert B, Fein M (2007) Who benefits from gastric banding? Obes Surg 17:1608–1613PubMedCrossRef

28.

Chevallier JM, Paita M, Rodde-Dunet MH, Marty M, Nogues F, Slim K, Basdevant A (2007) Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg 246:1034–1039PubMedCrossRef

29.

Dallal RM, Quebbemann BB, Hunt LH, Braitman LE (2009) Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obes Surg 19:732–737PubMedCrossRef

30.

Lanyon RI, Maxwell BM (2007) Predictors of outcome after gastric bypass surgery. Obes Surg 17:321–328PubMedCrossRef

31.

Lutfi R, Torquati A, Sekhar N, Richards WO (2006) Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc 20:864–867PubMedCrossRef

32.

Ma Y, Pagoto SL, Olendzki BC, Hafner AR, Perugini RA, Mason R, Kelly JJ (2006) Predictors of weight status following laparoscopic gastric bypass. Obes Surg 16:1227–1231PubMedCrossRef

33.

Averbukh Y, Heshka S, El-Shoreya H, Flancbaum L, Geliebter A, Kamel S, Pi-Sunyer FX, Laferrere B (2003) Depression score predicts weight loss following Roux-en-Y gastric bypass. Obes Surg 13:833–836PubMedCrossRef

34.

van Hout GC, Hagendoren CA, Verschure SK, van Heck GL (2009) Psychosocial predictors of success after vertical banded gastroplasty. Obes Surg 19:701–707PubMedCrossRef

35.

Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DE, Kelly JJ (2003) Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 138:541–545PubMedCrossRef

36.

Bogardus C, Taskinen MR, Zawadzki J, Lillioja S, Mott D, Howard BV (1986) Increased resting metabolic rates in obese subjects with non-insulin-dependent diabetes mellitus and the effect of sulfonylurea therapy. Diabetes 35:1–5PubMedCrossRef

37.

Huang KC, Kormas N, Steinbeck K, Loughnan G, Caterson ID (2004) Resting metabolic rate in severely obese diabetic and nondiabetic subjects. Obes Res 12:840–845PubMedCrossRef

38.

Swinburn BA, Nyomba BL, Saad MF, Zurlo F, Raz I, Knowler WC, Lillioja S, Bogardus C, Ravussin E (1991) Insulin resistance associated with lower rates of weight gain in Pima Indians. J Clin Invest 88:168–173PubMedCrossRef

39.

Weyer C, Pratley RE, Salbe AD, Bogardus C, Ravussin E, Tataranni PA (2000) Energy expenditure, fat oxidation, and body weight regulation: a study of metabolic adaptation to long-term weight change. J Clin Endocrinol Metab 85:1087–1094PubMedCrossRef

40.

Leibel RL, Rosenbaum M, Hirsch J (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332:621–628PubMedCrossRef

41.

Yost TJ, Jensen DR, Eckel RH (1995) Weight regain following sustained weight reduction is predicted by relative insulin sensitivity. Obes Res 3:583–587PubMed

42.

Shin RB (2005) Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 1:91–94PubMedCrossRef

Title: Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery
Authors: Emilio Ortega
Rosa Morínigo
Lilliam Flores
Violeta Moize
Martin Rios
Antonio M. Lacy
Josep Vidal
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 6/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-2104-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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