Importance: Few studies have compared mid-term results of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy and none have focussed on lipid profile.
Objectives: The main objective of this study was to compare laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy with respect to 5-year remission rate of the different lipid disturbances. Secondary outcomes included relapse, late remission and incidence rates of the different lipid disorders and evaluation of factors associated with mid-term remission. Design, setting and participants: A retrospective analysis of a non-randomised prospective cohort was conducted on patients with severe obesity undergoing bariatric surgery at Hospital del Mar, Barcelona, from January 2005 to January 2012 with ≥ 5 years follow-up.
Exposure: Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. Main outcome: 5-year remission rate of lipid disorders after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy.
Results: 87% of the patients were women, mean age of the total cohort was 46.1±8.7 years and BMI 45.2±4.8 kg/m2. Of the 259 patients who underwent bariatric surgery between 2005 and January 2012, 151 completed 5 years follow-up. The 5-year remission rate of high low-density lipoprotein cholesterol was superior after laparoscopic Roux-en-Y gastric bypass with respect to laparoscopic sleeve gastrectomy [61.2% (30/49) versus 26.1% (6/23); P=0.011] being male sex, absence of statins treatment and type of bariatric surgery technique (laparoscopic Roux-en-Y gastric bypass) the associated factors with remission. Hypertriglyceridemia remission was also higher after laparoscopic Roux-en-Y gastric bypass [92.0% (23/25) versus 66.7% (10/15); P=0.041], although type of surgery was not an associated factor. No differences were found in remission rates of low high-density lipoprotein cholesterol between groups. Absence of fibrates treatment and 5-year percentage of excess weight loss were independently associated with hypertriglyceridemia remission and only the latter was independently associated with low high-density lipoprotein cholesterol remission 5 years after surgery.
Conclusions: Five-year outcome data showed that, among patients with severe obesity undergoing bariatric surgery, laparoscopic Roux-en-Y gastric bypass was more effective than laparoscopic sleeve gastrectomy in terms of total and low-density lipoprotein cholesterol reduction and remission, with no differences in hypertriglyceridemia and high-density lipoprotein cholesterol normalization.
19 - 22 May 2018
European Society of Endocrinology