Outcomes variation in weight and resolution of obesity co-morbidities between five bariatric operations

Abstract

Purpose: Several bariatric operations are utilized to treat the growing obesity epidemic. The goal of this study was to identify variations in post-operative weight loss and obesity-related co-morbidities between the most commonly performed weight loss operations. Methods: Data from 166,601 patients in the Surgical Review Corporation’s Bariatric Outcomes Longitudinal Database (BOLD) who underwent Laparoscopic Adjustable Gastric Banding (LAGB, n=67,514), Bilio-Pancreatic Diversion/Duodenal Switch (BPD/DS, n=1,673), laparoscopic (LRYGB, n=83,059) and open (RYGB, n=5,389) Roux-en-Y gastric bypass, and Laparoscopic Sleeve Gastrectomy (SG, n=8966 ) was analyzed at baseline, and at 2, 4, 6, 12, 18, and 24 months post-operatively. Weight, BMI, and 29 weight related medical conditions were analyzed. Statistics: Continuous variables were analyzed using ANOVA with treatment in the model. General Linear Models included baseline and post-operative data, modified for binomial distribution of dichotomous variables. Results: BPD/DS patients had the lowest weight at 24 months and highest resolution of hypertension, diabetes, hyperlipidemia, and asthma, but most increase in cholelithiasis, liver disease, abdominal hernias, and psychological disorders. LRYGB best treated GERD and somatic disorders. OSA and gout resolved most after SG. LAGB was least effective in weight loss and co-morbidity resolution, but least likely to develop post-op liver disease, cholelithiasis, abdominal hernias, and symptomatic abdominal skin. Conclusions: Post-operative weight loss and rates of obesity-related co-morbidities vary between LAGB, BPD/DS, RYGB, LRYGB, and SG. Knowledge of these differences can help guide the pre-operative evaluation of obese patients presenting for weight loss surgery