Type of weight loss surgery matters for people with severe obesity

[September 07, 2018]  By Lisa Rapaport

(Reuters Health) - People who have weight-loss surgery for extreme obesity may lose more weight with an older operation known as Roux-en-Y gastric bypass than with a newer sleeve gastrectomy procedure, a small U.S. study suggests.

Researchers followed 59 obese patients who had sleeve gastrectomy operations between 2006 and 2009, before this type of weight-loss operation was widely accepted or covered by insurance. Back then, this operation was generally reserved for patients who were either "super-obese" or who had other medical conditions that made Roux-en-Y gastric bypass (RYGB) too risky.

Researchers compared these patients to a similar group of severely obese or high-risk surgical patients who had the more commonly performed RYGB surgery.

After seven years, both types of surgery were associated with lasting weight loss as well as reductions in obesity-related health problems like diabetes, high blood pressure and elevated cholesterol, the study found.

But sleeve gastrectomy was tied to less weight loss: 24 percent versus 30 percent with RGYB.

"For those higher risk bariatric surgical patients, it would be reasonable for them to consider that a RYGB may be a better choice than a sleeve gastrectomy, especially if longer-term weight loss is an important goal," said lead study author Dr. Bestoun Ahmed of the University of Pittsburgh Medical Center.

"Additionally, there is more and longer-term evidence in the literature of weight loss durability with RYGB," Ahmed said by email.

With a sleeve gastrectomy, surgeons divide and remove around 80 percent of the stomach using special surgical staplers, which leaves the stomach looking like a long thin banana, said Dr. Oliver Varban, director of the adult bariatric surgery program at Michigan Medicine in Ann Arbor.

For the RYGB operation, the same surgical staplers are used to divide the stomach to create a small pouch about the size of an egg, said Varban, who wasn't involved in the study. Surgeons then create a connection between the pouch and the small intestine so that food travels directly into the end of the small intestine, bypassing the stomach and the first portion of the small intestine.

While previous studies have linked RYGB to better long-term weight loss than sleeve gastrectomy, the study results offer fresh evidence that both procedures may have lasting health benefits, Varban said by email.

"They show that both procedures have profound benefits (in terms of) diabetes, hypertension and hyperlipidemia, even though weight loss outcomes were not the same," Varban said. "This is an important point as it suggests that both gastric bypass and sleeve gastrectomy produce similar health effects and that weight loss alone may not be the best metric for success."

As recently as 2011, sleeve gastrectomy accounted for less than one-fifth of bariatric procedures, but by 2016 it accounted for more than half of these operations, researchers note in Surgery.

"It is somewhat premature to declare the issue of the comparison between sleeve gastrectomy and RYGB established," as there isn't much data yet on long-term outcomes after sleeve gastrectomy, said Dr. Bruce Wolfe, a researcher at Oregon Health and Science University who wasn't involved in the study.

"One of the major challenges ... is long-term complications, particularly those that require reoperation," Wolfe said by email.

Surgical weight loss has gained traction in recent years as a growing number of extremely obese patients turn to this option after failing to lose weight through diet, exercise or medication. Like all surgery, it isn't risk free, and bariatric operations in particular carry a risk of malnutrition.

While more research is still needed with longer-term outcomes, results from the current study and other research to date suggest that what's best for severely obese patients may be different than what's ideal for people who aren't quite as obese, said Dr. Brian Smith of UC Irvine Health in Orange, California.

"Taken as a whole, these studies suggest that standard obese patients do well with sleeve or gastric bypass, but that larger patients may benefit most from more aggressive operations such as gastric bypass," Smith, who wasn't involved in the study, said by email.

SOURCE: http://bit.ly/2Njstlf Surgery, online August 20, 2018.

[© 2018 Thomson Reuters. All rights reserved.]

Copyright 2018 Reuters. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.  Thompson Reuters is solely responsible for this content.