Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

Abstract

Background: Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program.

Methods: We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data.

Results: We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (-13.0 ± 6.6) than both the LSG (-7.6 ± 5.7) and the LAGB (-2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%.

Conclusion: In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe.

Fig. 1

Patient enrolment and 2-year follow-up completion among surgical groups. LAGB = laparoscopic adjustable gastric banding; LSG = laparoscopic sleeve gastrectomy; RYGB = laparoscopic Roux-en-Y gastric bypass.

Fig. 2

Weight change among surgical subgroups. Data presented as (A) absolute weight change, (B) relative weight change and proportion of participants achieving weight loss greater than (C) 5% and (D) 10% of baseline. The p values represent significanvce in overall differences among surgical subgroups using 2-way analysis of variance (ANOVA). *p < 0.05 compared to LAGB using a Bonferroni post hoc correction after 2-way ANOVA. LAGB = laparoscopic adjustable gastric banding; LSG = laparoscopic sleeve gastrectomy; RYGB = laparoscopic Roux-en-Y gastric bypass.

Fig. 3

Absolute and relative change in prevalence of comorbidities 2 years after surgery. Data presented as (A) absolute and (B) relative reduction in the proportion of participants with diabetes, hypertension and dyslipidemia 2 years after bariatric surgery. *Represents a significant change in prevalence (p < 0.05) relative to baseline in the same surgical subgroup. †Represents a significant difference in the prevalence of each risk factor compared to the effect observed in the those receiving laparoscopic adjustable gastric banding (LAGB). LSG = laparoscopic sleeve gastrectomy; RYGB = laparoscopic Roux-en-Y gastric bypass.