Tailoring Bariatric Surgery: Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch

Jul 31, 2018Journal of laparoendoscopic & advanced surgical techniques. Part A

Choosing Between Sleeve Gastrectomy, Gastric Bypass, and Biliopancreatic Diversion with Duodenal Switch for Weight-Loss Surgery

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Abstract

Among 73,702 subjects, 5,942 patients underwent sleeve gastrectomy (SG), while 66,324 underwent Roux-en-Y gastric bypass (RYGB) and 1,436 underwent biliopancreatic diversion with duodenal switch (BPD/DS).

At 1 year, BMI decreased by 5.3 units for BPD/DS and by 2.2 units for RYGB compared to SG.
RYGB was associated with the highest resolution of gastroesophageal reflux disease (GERD) with an odds ratio (OR) of 1.88.
BPD/DS showed better resolution rates for hypertension and diabetes mellitus (DM), with ORs of 2.12 and 2.53, respectively.
RYGB also improved hypertension and DM resolution, with ORs of 1.54 and 1.63, respectively.
The odds of serious adverse events at 1 year were higher for BPD/DS (OR = 4.31) compared to RYGB (OR = 1.70).

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BACKGROUND: A need exists to select the most appropriate bariatric operation for a particular patient. One-year data comparing sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS) are sparse.

METHODS: The Bariatric Outcomes Longitudinal Database was queried from June 2007 to September 2011 for 30-day and 1-year adverse events, and 1-year weight loss and comorbidity resolution. Propensity scores with inverse probability weighting were used to match for age, gender, body mass index (BMI), ethnicity, and select comorbidities. Multivariate linear and logistic regressions estimated differences and odds ratios (ORs), respectively, for each pairwise bariatric operation comparison.

RESULTS: Among 73,702 subjects, 5942 patients underwent SG, 66,324 patients underwent RYGB, and 1436 patients underwent BPD/DS. Compared with SG, decrease in BMI units was greater by 5.3 for BPD/DS and by 2.2 U for RYGB at 1 year. Resolution of gastroesophageal reflux disease (GERD) was best for RYGB (OR = 1.88, 95% confidence interval [CI]: 1.73-2.03) and still good for BPD/DS (OR = 1.57, 95% CI: 1.29-1.90). Hypertension and diabetes mellitus (DM) resolution were better after BPD/DS (OR = 2.12, 95% CI: 1.83-1.64, and OR = 2.53, 95% CI: 2.13-3.00, respectively) and for RYGB were (OR = 1.54, 95% CI: 44-1.64 and OR = 1.63, 95% CI: 1.51-1.75, respectively). Odds of serious adverse events at 1 year were: RYGB, OR = 1.70, 95% CI: 1.45-2.00; BPD/DS, OR = 4.31, 95% CI: 3.06-6.07.

CONCLUSIONS: Using SG as reference, RYGB was associated with highest resolution of GERD, whereas BPD/DS was associated with highest resolution of DM and hypertension. These findings can guide decision making regarding choice of bariatric operation.

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Tailoring Bariatric Surgery: Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch

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