January 19, 2018
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Sleeve gastrectomy, gastric bypass similarly successful in reducing BMI

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Patients with morbid obesity who underwent either laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass procedures had similar success in reducing their excess BMI, according to an investigation published in JAMA.

Additionally, Ralph Peterli, MD, of the department of surgery at St. Claraspital, in Basel, Switzerland, and colleagues found that both procedures reduced comorbidities such as diabetes and dyslipidemia. However, gastric bypass was more successful in reducing instances of GERD while GERD worsened in patients who underwent sleeve gastrectomy.

“The sleeve gastrectomy procedure is technically easier, faster to perform, and potentially safer compared with Roux-en-Y gastric bypass,” they wrote. “However, much more data on clinical and metabolic long-term outcomes are available on the Roux-en-Y gastric bypass procedure.”

Peterli and colleagues randomly assigned 217 patients with morbid obesity to undergo either sleeve gastrectomy (n = 107) or gastric bypass (n = 110). The patients underwent their procedures between January 2007 and November 2011, with the final follow-up conducted in March 2017.

Researchers assessed the patients for weight loss, defined as a percentage excess BMI loss over a 5-year period.

During the 5-year observation period, there were no statistically significant differences in percentage excess BMI loss for sleeve gastrectomy compared with gastric bypass (61.1% vs 68.3%; absolute difference, –7.18%; 95% CI, –14.30% to –0.06%).

Investigators also found that gastric bypass was more effective in treating preexisting GERD, and they observed a worsening of GERD symptoms more often in the patients who underwent sleeve gastrectomy procedures. Although these symptoms could regularly be treated with proton pump inhibitors, the treatment was ineffective in nearly 10% of patients, and sleeve gastrectomy had to be converted to gastric bypass.

In an editorial published in JAMA, David Arterburn, MD, MPH, of Kaiser Permanente Washington Health Research Institute and the department of medicine at the University of Washington, and Anirban Gupta, MD, of the bariatric surgery program at Washington Permanente Medical Group, wrote that this study, as well as others on the topic, provided enough data to assure physicians that the seemingly rapid switch from gastric bypass to sleeve gastrectomy in the last several years has not be a “therapeutic misadventure.”

“These and other studies suggest that sleeve gastrectomy and bypass are overall quite similar in terms of their effects on weight and comorbid conditions through 5 years,” they wrote. “Several lessons from these studies can help surgeons improve shared decision making around the choice between sleeve gastrectomy and gastric bypass for the individual patient.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.