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Comparative Study
. 2016 Aug;59(4):233-41.
doi: 10.1503/cjs.013315.

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

Richdeep S Gill  1 , Sumit R Majumdar  1 , Christian F Rueda-Clausen  1 , Sameer Apte  1 , Daniel W Birch  1 , Shahzeer Karmali  1 , Arya M Sharma  1 , Scott Klarenbach  1 , Raj S Padwal  1
Affiliations
Comparative Study

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

Richdeep S Gill et al. Can J Surg. 2016 Aug.

Abstract
in English, French

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.

Background: Au Canada, la chirurgie bariatrique est effectuée principalement dans des cliniques spécialisées financées par le secteur public. Des études ont démontré que les interventions de cette nature sont supérieures à la prise en charge médicale intensive pour la perte de poids et la réduction des affections comorbides liées à l'obésité. L'objectif de notre étude était de comparer l'efficacité et l'innocuité de la dérivation gastrique Roux-en-Y par laparoscopie (DGRY), de la gastrectomie longitudinale (GL) et de la gastroplastie par anneau gastrique modulable (GAGM) dans le cadre d'un programme de traitement bariatrique basé sur la population financé par les deniers publics.

Methods: Nous avons suivi pendant 2 ans des patients ayant subi une chirurgie bariatrique. Le résultat primaire à l'étude était la variation pondérale (en kilogrammes). Nous avons analysé la variation intergroupe au moyen d'une régression multivariable et utilisé la méthode d'imputation des données manquantes par report de la dernière observation.

Results: Nous avons retenu 150 patients consécutifs (51 DGRY; 51 GL; 48 GAGM). Au début de l'étude, l'âge moyen était de 43,5 ± 9,5 ans, 87,3 % des patients étaient des femmes, et leur indice de masse corporelle (IMC) avant l'opération était de 46,2 ± 7,4. Après 2 ans, la perte de poids moyenne (pourcentage du poids de départ) était de 36,6 ± 19,5 kg (26,1 ± 12,2 %) pour la DGRY, de 21,4 ± 16,0 kg (16,4 ± 11,6 %) pour la GL, et de 7,0 ± 9,7 kg (5,8 ± 7,9 %) pour la GAGM (p < 0,001). La variation de l'IMC était plus grande pour le groupe DGRY (13,0 ± 6,6) que pour les 2 autres groupes (7,6 ± 5,7 pour la GL et 2,6 ± 3,5 pour la GAGM; p < 0,001). L'incidence sur le diabète, l'hypertension et la dyslipidémie était également plus grande après la DGRY qu'après la GAGM (p < 0,05 pour tous). Il n'y a eu aucun décès. Le taux de fuites anastomotiques et liées aux sutures était de 1,3 %.

Conclusion: Dans le cadre d'un programme de chirurgie bariatrique basé sur une population et financé par le secteur public, la DGRY et la GL ont entraîné une plus grande perte de poids que la GAGM. La dérivation a donné lieu à la plus forte réduction des affections comorbides liées à l'obésité. Toutes les interventions se sont avérées sécuritaires.

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Figures

Fig. 1
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
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
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.
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