Top

Obesity Surgery

Published in:

01-08-2021 | Obesity | Original Contributions

Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB

Authors: Tien-Chou Soong, Ming-Hsien Lee, Wei-Jei Lee, Owaid M. Almalki, Jung-Chien Chen, Chun-Chi Wu, Shu-Chun Chen

Published in: Obesity Surgery | Issue 8/2021

Abstract

Background

The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m²) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients.

Methods

Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted.

Results

The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m². Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%).

Conclusion

SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.

Graphical Abstract

Gary KD, Pomp A, Dakin G, et al. Perioperative outcomes and anesthetic considerations of robotic bariatric surgery in a propensity-matched cohort of super obese and super-euper obese patients. Surg Endosc. 2018;32(12):4867–73.CrossRef

Wilkinson KH, Helm M, Lak K, et al. The risk of post-operative complications in super-super obesity compared to super obesity in accredited bariatric surgery centers. Obes Surg. 2019;29(9):2964–71.PubMedCrossRef

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef

Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRef

Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoliminal procedure: IFSO worldwide survey 2014. Obes Surg. 2017;27:2279–89.PubMedPubMedCentralCrossRef

Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.PubMedCrossRef

Noel P, Nedelcu M, Eddbali I, et al. What are the long-term results 8 years after sleeve gastrectomy ? Surg Obes Relat Dis. 2017;13:1110–5.PubMedCrossRef

Gadiot RPM, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2017;27:59–63.PubMedCrossRef

Ece I, Yilmaz H, Alptekin H, et al. Comparative effectiveness of laparoscopic sleeve gastrectomy on morbidly obese, super-obese, and super-super obese patients for the treatment of morbid obesity. Obes Surg. 2018;28(6):1484–91.PubMedCrossRef

10.

Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilatation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27:3092–101.PubMedCrossRef

11.

Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated longterm complication. Surg Obes Relat Dis. 2017;13(4):568–74.PubMedCrossRef

12.

Chang DM, Lee WJ, Chen JC, et al. Thirteen-year experience of laparoscopic sleeve gastrectomy: surgical risk, weight loss and revision procedures. Obes Surg. 2018;28:2991–7.PubMedCrossRef

13.

Wang Y, Song YH, Chen J, et al. Roux-en-Y gastric bypass versus sleeve gastrectomy for super super obese and super obese: systematic review and meta-analysis of weight results, comorbidity resolution. Obes Surg. 2019;29(6):1954–64.PubMedCrossRef

14.

Uno K, Seki Y, Kasama K, et al. A comparison of the bariatric procedures that are performed in the treatment of super morbid obesity. Obes Surg. 2017;27:2537–45.PubMedCrossRef

15.

Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity. Ann Surg. 2005;242:20–8.PubMedPubMedCentralCrossRef

16.

Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22:697–70.PubMedCrossRef

17.

Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24:1749–56.PubMedCrossRef

18.

Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11:321–7.PubMedCrossRef

19.

Plamper A, Lingohr P, Nadal J, et al. Comparison of mini-gastric bypass with sleeve gastrectomy in a mainly super-obese patient group: first results. Surg Endosc. 2017;31:1156–62.PubMedCrossRef

20.

Madhok B, Mahawar KK, Boyle M, et al. Management of super super obese patients: comparison between mini (one anastomosis) gastric bypass and sleeve gastrectomy. Obes Surg. 2016;26:1646–9.PubMedCrossRef

21.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedPubMedCentralCrossRef

22.

Lee WJ, Chen JC, Yao WC, et al. Transumbilical 2-site laparoscopic Roux-en-Y gastric bypass: initial results of 100 cases and comparison with traditional laparoscopic technique. Surg Obes Relat Dis. 2012;8(2):208–13.PubMedCrossRef

23.

Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18:294–9.PubMedCrossRef

24.

Soong TC, Almalki OM, Lee WJ, et al. Measuring the small bowel length may decrease the incidence of malnutrition after laparoscopic one-anastomosis gastric bypass with tailored bypass limb. Surg Obes Relat Dis. 2019;15(10):1712–8.PubMedCrossRef

25.

Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24(9):2253–9.PubMedCrossRef

26.

Petersorz K, Anderson J, Bandy E, et al. Rapid evidence review of bariatric surgery in super obesity (BMI > 50Kg/m²). J Gen Intern Med. 2017;32:56–64.CrossRef

27.

Betencourt-Silva R, Neves JS, Pedro J, et al. Comparative effectiveness of different bariatric procedures in super morbid obesity. Obes Surg. 2019;29:281–91.CrossRef

28.

Riestad H, Sovik TT, Engstrom MY, et al. Five years outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized trial. JAMA Surg. 2015;150(4):352–61.CrossRef

29.

Skogar ML, Sundbom M. Duodenal switch is superior to gastric bypass in patients with super obesity after evaluated with the bariatric analysis and reporting outcome system (BAROS). Obes Surg. 2017;27:2308–16.PubMedPubMedCentralCrossRef

30.

Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.PubMedCrossRef

31.

Merz AE, Blackstrom RB, Gagner M, et al. Duodenal switch in revisional surgery: conclusions from an expert consensus panel. Surg Obes Relat Dis. 2019;15(6):894–9.PubMedCrossRef

32.

Chang DM, Lee WJ, Chen JC, et al. Thirteen-year experience of laparoscopic sleeve gastrectomy: surgical risk, weight loss, and revision procedures. Obes Surg. 2018;28(10):2991–7.PubMedCrossRef

33.

Svanevik M, Risstad H, Hofso D, et al. Perioperative outcomes of proximal and distal gastric bypass in patients with BMI range 50-60 kg/m(2): a double-blind, randomized controlled trial. Obes Surg. 2015;25(10):1788–95.PubMedPubMedCentralCrossRef

34.

Shah K, Nergard BJ, Fagerland MW, et al. Limb length in gastric bypass in super-obese patient: importance of length of total alimentary small bowel tract. Obes Surg. 2019;39:2012–21.CrossRef

35.

Ghiassi S, Higa K, Chang S, et al. Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome: 3-year follow-up and evolution of technique to reduce nutritional complications. Surg Obes Relat Dis. 2018;14(5):554–61.PubMedCrossRef

36.

Chen JC, Shen CY, Lee WJ, et al. Protein deficiency after gastric bypass: the role of common limb length in revision surgery. Surg Obes Relat Dis. 2019;15(3):441–6.PubMedCrossRef

37.

Fink J, Pigenot A, Seifert G, et al. Banded versus non-banded sleeve gastrectomy: 5-year results of a matched-pair analysis. Surg Obes Relat Dis. 2019;15(8):1233–8.PubMedCrossRef

38.

Lemmens L. Banded gastric bypass: better long-term results ? A cohortstudy with minimum 5-year follow-up. Obes Surg. 2017;27(4):864–7.PubMedCrossRef

39.

Magw DU, Uema M, Coelbo-Neto JS, et al. Long-term weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10 years follow-up study. Surg Obes Relat Dis. 2018;14(7):910–7.CrossRef

40.

Miller KA, Padaner M, Buchwald JN, et al. 5-year results of banded one anastomosis gastric bypass: a pilot study in super obese patients. Obes Surg. 2020;30:4307–14.PubMedCrossRef

Title: Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB
Authors: Tien-Chou Soong
Ming-Hsien Lee
Wei-Jei Lee
Owaid M. Almalki
Jung-Chien Chen
Chun-Chi Wu
Shu-Chun Chen
Publication date: 01-08-2021
Publisher: Springer US
Keywords: Obesity
Obesity
Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 8/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-021-05464-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 8/2021

Endoscopic Sleeve Gastroplasty (ESG) for High-Risk Patients, High Body Mass Index (> 50 kg/m2) Patients, and Contraindication to Abdominal Surgery

Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-uncomplicated Sleeve Gastrectomy

Evolution of Non-alcoholic Fatty Liver Disease (NAFLD) Biomarkers in Response to Weight Loss 1 Year After Bariatric Surgery—a Post Hoc Analysis of the FibroTest Prospective Study

Changes of Carotid Intima-Media Thickness After Sleeve Gastrectomy in High Cardiovascular Risk Patients: a Prospective Study

Controlling Nutritional Status (CONUT) Score and Micronutrient Deficiency in Bariatric Patients: Midterm Outcomes of Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass/Mini Gastric Bypass

Correlation Between Anthropometric Measurements and Non-alcoholic Fatty Liver Disease in Individuals With Obesity Undergoing Bariatric Surgery: Cross-Sectional Study