ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 49 OC11.2 | DOI: 10.1530/endoabs.49.OC11.2

Three year prospective study in morbidly obese patients between longitudinal gastrectomy and gastric bypass based on a composite outcome combining weight loss efficacy and surgery related complications (PHRC SLEEVE K060213 / IDRCB2007-A00373-50)

Jean Marc Catheline1, Marinos Fysekidis2, Yasmina Bendacha1, Najib Bdeoui1, Vidhya Raghavan3, Sophie Gérard3, Jean Jacques Portal3, Rami Dbouk1, Jean Michel Fabre4, Gilles Fourtanier5, Jean Gugenheim6, Noël Huten7, Maxime Sodji8, Simon Msika9, Michel Scotté10, Eric Vicaut3 & Regis Cohen1

1Centre coordinateur du PHRC, Centre Hospitalier de Saint-Denis, Saint-Denis, France; 2CHU Bobigny, Bobigny, France; 3Unité de Recherche Clinique Lariboisière-St Louis Hôpital Fernand Widal, Paris, France; 4CHU de Montpellier, Montpellier, France; 5CHU Toulouse, Toulouse, France; 6CHU Nice, Nice, France; 7CHU Tours, Tours, France; 8Clinique Emailleurs, Limoge, France; 9Hôpital Louis Mourier « APHP », Colombes, France; 10CHU Rouen, Rouen, France.

Since its first description in 2000, Longitudinal Gastrectomy (LG) has become the first surgical procedure in the treatment of morbid obesity in the world, exceeding in numbers Gastric Bypass (GB). GB is considered to have better results regarding long-term weight loss and improvement in co-morbidities. We aimed to demonstrate that LG is non inferior to GB for a composite end point that included more than 50% excess weight loss from the baseline and surgery related complications after a mean follow-up of 36 months. This is a prospective study in morbidly obese patients that tested a two hypotheses composite outcome: the first hypothesis was that after 36 months LG was non-inferior to GB regarding EWL (the predefined margin of non-inferiority was ±15%), and the second hypothesis was the presence of significant difference in post-operative morbidity and mortality. From February 2008 to March 2015 we included 277 patients (91 GB vs 186 LG). The mean age was 41.1 years, 19.2% had a previous bariatric operation, 85.9% were women and the average pre-intervention BMI was 45.3 kg/m2. At baseline there were no significant differences between the GB and LG for age, sex and BMI. The % of patients with EWL > 50% was at 18 months for 82.1% (GB) vs 84.5% (LG), and 79.1 vs. 79.5% respectively at 36 months. The estimated difference in EWL was [−10.5% to 9.8%], confirming the non-inferiority of LG compared to BP. Finally there was a significant less morbidity and mortality for the LG group (GB vs LG, 12.1 vs. 4.8%, one death for LG, P=0.01). This is the first prospective study demonstrating that LG is not inferior to GB for an estimated 10% difference in EWL but with less surgical complications. These results reinforce the choice of LG as surgical procedure for obesity.

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