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.Contexte : 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.Méthodes : 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.Résultats : 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 p...

Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial

“…For example, complications observed in the STAMPEDE Trial of gastric bypass and sleeve gastrectomy compared to medical therapy for the treatment of diabetes through 3 years included intra-abdominal bleeding (and subsequent need for transfusion), gastrointestinal leak, bowel obstruction, dehydration requiring intravenous treatment, stricture, ulcers, and ketoacidosis [12, 13]. Weight loss with vBloc was shown to be similar to that reported for laparoscopic adjustable gastric banding (LAGB) in a 2-year report comparing bypass, sleeve, and LAGB where the completed case evaluation showed 6 ± 8.2 % TWL with LAGB compared to 8 ± 9.5 % TWL with vBloc [14]. …”

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

“…Proportion meta-analysis of randomized and observational studies found a pooled incidence of 20% (95% CI 13% to 26%, df = 10, I 2 = 89%) for complications requiring surgical intervention, 2% (95% CI 1% to 3%, df = 7, I 2 = 0%) for band erosion, 7% (95% CI 4% to 10%, df = 9, I 2 = 72%) for band removal, 4% (95% CI 3% to 5%, df = 6, I 2 = 0) for port revision, and 19% (95% CI 12 to 26%, df = 8, I 2 = 85%) for overall complications [77][78][79][80][81][82][83][84][85][86][87][88][89].…”

Assessment of Nurses’ Knowledge toward Sleeve Gastrectomy in Surgical Unit at Al-Najaf Al-Ashraf Governorate

“…(14) but disagrees with study in America by. (15) Most of nurses don't have good knowledge about gastrectomy because this operation is considered new method in Iraq to decrease the weight and most of nurses don't read about this operation in there study program, that is mean all of nurses equal to have bad knowledge, for this reason association cannot be found between overall assessment of nurses knowledge about sleeve gastrectomy and their demographic data between overall assessment of nurses knowledge about sleeve gastrostomy and their demographic data, this result agree with Hameed (2006), he pointed no significant correlation between overall assessment of nurses' knowledge and their demographic data (16)…”