Abstract
Background
Laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic
adjustable gastric banding all lead to substantial weight loss in obese patients.
Long-term weight loss can be highly variable beyond 1-year postsurgery. This study
examines and compares the frequency distribution of weight loss and lack of treatment
effect rates after laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy,
and laparoscopic adjustable gastric banding.
Methods
A total of 1,331 consecutive patients at a single academic institution were reviewed
from a prospectively collected database. Preoperative data collected included demographics,
body mass index, and percent excess weight loss. Postoperative BMI and %EWL were collected
at 12, 24, and 36 months. Percent excess weight loss was analyzed by the percentiles
of excess weight lost, and the distribution of percent excess weight loss was evaluated
in 10% increments. Lack of a successful treatment effect was defined as <25% excess
weight loss.
Results
Of the 1,331 patients, 72.4% (963) underwent laparoscopic Roux-en-Y gastric bypass,
18.3% (243) laparoscopic sleeve gastrectomy, and 9.4%(125) laparoscopic adjustable
gastric banding. Mean percent excess weight loss was greatest for laparoscopic Roux-en-Y
gastric bypass, followed by laparoscopic sleeve gastrectomy, and then by laparoscopic
adjustable gastric banding at every time point: at 2 years mean percent excess weight
loss was 77.9± 24.4 for laparoscopic Roux-en-Y gastric bypass, 50.8 ± 25.8 for laparoscopic
sleeve gastrectomy, and 40.8± 25.9 for laparoscopic adjustable gastric banding (P < .0001). The rates of a successful treatment effect s for laparoscopic Roux-en-Y
gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric
banding were 0.9%, 5.2%, and 24.3% at 1 year; 0.3%, 11.1%, and 26.0% at 2 years; and
1.0%, 25.3%, and 30.2% at 3 years. At 1 year, the odds ratio of lack of a successful
treatment effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y
gastric bypass was 6.305 (2.125–19.08; P = .0004), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic
Roux-en-Y gastric bypass was 36.552 (15.64–95.71; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic
sleeve gastrectomy was 5.791 (2.519–14.599; P < .0001). At 2 years, the odds ratio for laparoscopic sleeve gastrectomy versus laparoscopic
Roux-en-Y gastric bypass increased to 70.7 (9.4–531.7; P < .0001), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic
Roux-en-Y gastric bypass increased to 128.1 (16.8–974.3; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic
sleeve gastrectomy decreased to 1.8 (0.9–3.6; P = .09).
Conclusion
This study emphasizes the existing variability in weight loss across bariatric procedures
as well as in the lack of a treatment effect for each procedure. Although laparoscopic
adjustable gastric banding has the greatest rate of a lack of a successful treatment
effect, the rate remained stable over 3 years postoperatively. Laparoscopic sleeve
gastrectomy showed a doubling in the rate of a lack of a successful treatment effect
every year reaching 25% at year 3. The rates for lack of a successful treatment effect
for laparoscopic Roux-en-Y gastric bypass remained stable at about 1% for the first
3 years postoperatively.
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Article info
Publication history
Published online: October 10, 2018
Accepted:
August 21,
2018
Received in revised form:
August 16,
2018
Received:
January 22,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
