Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity

Abstract

Background Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) is a loop modification of biliopancreatic diversion with duodenal switch. The aim of this study was to analyze weight loss response and factors predicting weight loss outcomes after SG LDJB. Methods This was a retrospective study analyzing SG LDJB surgeries performed between May 2013 and December 2017 in 126 Indians suffering from obesity. The collected data was analyzed to understand weight loss efficacy and the factors predicting weight loss. Surgery was considered successful when percentage excess weight loss (%EWL) was ≥50% or percentage total weight loss (%TWL) was ≥25%. Results %EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-up, respectively. %EWL ≥50% was 99.04% and 96.47% and %TWL ≥25% was 91.35% and 75.29% at the 1-year and 3-year follow-up, respectively. Patient age and sex did not independently predict %EWL or %TWL. Preoperative body mass index (BMI), weight, and excess weight negatively predicted %EWL and positively predicted %TWL at the 1-year and 3-year follow-up. Multiple regression analysis showed that these parameters were independent predictors of %EWL and %TWL at 1 year, while preoperative weight and excess weight also independently predicted %EWL at the 3-year follow-up. In diabetic patients, %EWL was significantly lower at the 3-year follow-up and %TWL was significantly lower at the 1-year and 3-year follow-up. Conclusion SG LDJB was an effective bariatric surgery to treat obesity. Preoperative BMI, weight, excess weight, and the presence of diabetes were the significant factors associated with the weight loss outcomes.

Preoperative Serum Cortisol Level Is Predictive of Weight Loss After Laparoscopic Sleeve Gastrectomy in Men with Severe Obesity but Not Women

“…Recent studies have suggested that a good response to bariatric surgery should be defined as a %TWL of ≥ 25 [ 26 , 27 ]. We, therefore, divided the study patients into two groups with a %TWL of ≥ 25 or < 25.…”

Is the Sleeve Gastrectomy Sufficient or Does it Require Additional Surgical Procedures?

“…The reported rates of diabetes remission at 1 year with sleeve-DJB and sleeve-loop DJB were 86% and 62%, respectively; however, these procedures require meticulous surgical techniques [ 19 ]. According to recent data, %EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-ups respectively [ 22 ]. Diabetes remission reached a maximum of >90% of patients at the 1-year follow-up in patients with HbA1C levels of <6.5%.…”

Response: Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14)

“…These findings were similar for %TWL, and thus we selected only %TWL as a dependent variable in our study. 5 Furthermore, a preoperative BMI of <50 kg/m 2 in the majority of the patients prompted us to consider %EWL in our study.…”

“… 6 %EWL and %EBMIL (and %TWL and %TBMIL) can be used interchangeably as they yield exactly the same results, even though the formulas to calculate these variables are different. 5 van de Laar et al 8 suggested using alterable WL as a measure of weight-loss outcome as it is the only variable independent of preoperative BMI. It is better to analyze more variables, and interpret how each variable changes with different independent variables, rather than to define weight-loss outcomes based on a single variable to minimize the inherent bias of any inter-group comparisons based on a single variable.…”