Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 162-170
Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.162
Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study
Harshit Garg, Pratyusha Priyadarshini, Sandeep Aggarwal, Samagra Agarwal, Rachna Chaudhary
Harshit Garg, Pratyusha Priyadarshini, Sandeep Aggarwal, Rachna Chaudhary, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, India
Samagra Agarwal, Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Priyadarshini P and Aggarwal S designed the research and edited the manuscript; Garg H and Chaudhary R collected the material and clinical data of the patients; Garg H wrote the manuscript and did the data analysis; Agarwal S helped in data analysis and interpretation of results.
Institutional review board statement: Taken.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors confirm no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sandeep Aggarwal, MBBS, MS, FACS, Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5034, 5th floor, Teaching Block, Ansari Nagar, New Delhi 110029, India. sandeep_aiims@yahoo.co.in
Telephone: +91-11-26594905
Received: August 13, 2016
Peer-review started: August 16, 2016
First decision: September 2, 2016
Revised: December 30, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: April 16, 2017
Processing time: 244 Days and 9 Hours
Abstract
AIM

To compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.

METHODS

Forty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus (T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2DM, hypertension (HTN), obstructive sleep apnea syndrome (OSAS), hypothyroidism and gastroesophageal reflux disease (GERD).

RESULTS

Percentage excess weight loss (EWL%) was similar in LRYGB and LSG groups at one year follow-up (70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group (76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar (10% vs 7.5%, P = 0.99). The median duration of T2DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group (7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.

CONCLUSION

LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

Keywords: Bariatric surgery; Laparoscopic sleeve gastrectomy; Laparoscopic Roux-en-Y gastric bypass; Weight loss; Comorbidities

Core tip: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most popular bariatric procedures. Few studies have compared the outcomes of LSG vs LRYGB in terms of weight loss and comorbidity resolution, especially in India. Using case control design in a well-matched population of 40 patients each undergoing LSG and LRYGB, we found similar weight loss one year after surgery in both the groups but the weight loss was significantly higher in LRYGB group two years after surgery. The complication rate was similar in both groups. Regarding comorbidity resolution, both LRYGB and LSG had significant but similar impact on obesity related comorbidities except gastroesophageal reflux disease where LRYGB showed better improvement. This is also among the first few studies to study the impact of bariatric surgery on hypothyroidism.