Comparative Effectiveness of Different Bariatric Procedures in Super Morbid Obesity

Sep 26, 2018Obesity surgery

Comparing the Success of Different Weight-Loss Surgeries in Extremely Severe Obesity

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Abstract

In a study of 213 super obese patients, Roux-en-Y gastric bypass (RYGB) resulted in a 67.58% excess weight loss in the first year, significantly higher than other bariatric procedures.

The percentage of total weight loss (%TWL) in the first year was 36.29% for RYGB, compared to 31.59% for sleeve gastrectomy (SG) and 21.07% for adjustable gastric band (AGB).
At the two-year mark, RYGB continued to show significantly greater %EWL and %TWL compared to SG and AGB.
RYGB had a higher success rate for achieving at least 50% excess weight loss and 20% total weight loss in both follow-up years.
In an analysis adjusting for other factors, RYGB emerged as the only strong predictor of both %EWL and %TWL.

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BACKGROUND: Super obesity (BMI ≥ 50 kg/m) is associated with significant morbidity and mortality. The best procedure to treat super obesity is not completely established. Our aim was to compare the effectiveness of bariatric procedures (adjustable gastric band [AGB], Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]) in super obesity. 2

METHODS: Retrospective observational study of super obese patients who underwent bariatric surgery. Data was assessed preoperatively and in the 1st and 2nd years of follow-up.

RESULTS: We evaluated 213 individuals, 77.9% female, age of 43.38 ± 11.49 years, and preoperative BMI of 54.53 ± 4.54 kg/m; 19 submitted to AGB, 127 to RYGB, and 67 to SG. In the pre-surgical assessment, there were no significant differences in age, anthropometric parameters, blood pressure, glycemic profile, and lipid profile between the three surgical groups. The percentage of excess weight loss (%EWL) in the 1st year was 67.58% in RYGB, 58.74% in SG, and 38.71% in AGB (p < 0.001), and the percentage of total weight loss (%TWL) was 36.29%, 31.59%, and 21.07%, respectively (p < 0.001). Two years after surgery (n = 147; follow-up rate of 69%), the %EWL and %TWL were significantly higher in the RYGB group (p < 0.001). RYGB had a higher success rate (%EWL ≥ 50% and %TWL ≥ 20%) in both years of follow-up (p < 0.001). In multiple linear regression, after adjusting for other covariates, RYGB was the only strong predictive factor of %EWL and %TWL (p < 0.001). 2

CONCLUSION: RYGB proved to be more effective in super obesity. The beneficial effects in weight loss were evident both 1 and 2 years after the procedure, regardless of pre-surgical anthropometric characteristics.

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Comparative Effectiveness of Different Bariatric Procedures in Super Morbid Obesity

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