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

May 16, 2021Obesity surgery

Long-term weight loss results of three types of weight-loss surgery for extreme obesity: Sleeve gastrectomy, gastric bypass, and one-anastomosis bypass

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Abstract

At 5 years post-operation, OAGB achieved a 40.8% total weight loss compared to 35.1% for SG and 37.2% for RYGB.

The average patient age was 32.1 years, with an average BMI of 56.0 kg/m.
RYGB was associated with higher intraoperative blood loss, longer operating times, and longer hospital stays compared to SG and OAGB.
The major complication rate within 30 days post-operation was higher for RYGB (4.8%) than for SG (0.5%) and OAGB (0.8%).
SG had a lower revision rate (2.6%) compared to RYGB (8.1%) and OAGB (6.9%).
Remission rates for dyslipidemia were lower in SG compared to OAGB and RYGB, while remission rates for type 2 diabetes were similar across all groups.

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BACKGROUND: The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m) 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. 2

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/m. 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%). 2

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.

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

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