Rhys Kavanagh, MD, Smith Jessica, MD, Debra Allan, RN, MSN, Peter Nau, MD, MS. University of Iowa Hospitals and Clinics
Introduction: The roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric surgeries worldwide. Evidence suggests that the malabsorptive component of the RYGB leads to disparate changes in fat and lean mass when compared to that which is seen with restrictive-centric efforts. This can impart deleterious effects on the patient such as an inability to complete activities of daily living, decreased bone mineral density and basal metabolic rate. The SG omits the intestinal bypass and is thought to lack the malabsorptive qualities seen with the RYGB. Little evidence exists on the effects of SG on body composition. This study seeks to compare patients who received a RYGB to SG with regards to change in excess body weight and body composition using Air Displacement Plethysmography (BodPodTM). It is hypothesized that patients who undergo RYGB will experience more profound loss in lean body mass than with SG.
Methods: Patients were selected according to NIH guidelines for bariatric surgery and completed a full multidisciplinary evaluation and monitored weight loss preoperatively. Patients underwent SG or RYGB based on surgeon recommendation, patient preference and medical comorbidities. Body composition was calculated using whole body densitometery (BodPodTM, Cosmed Chicago, IL). Patients underwent testing pre-operatively, six months and 12 months post-operatively. Measurements of change in total body mass, fat mass and lean mass as well as calculation of change in percent excess body weight were performed. Statistical analysis was completed using SPSS.
Results: 63 patients were enrolled. 33 patients underwent SG and 30 had a RYGB. Mean %EBW loss for SG and RYGB was 47.2% and 53.4% respectively (P value = 0.17 95%CI -14.8 to 2.6). Mean % change in fat mass for the SG and RYGB groups was 9.2% and 10.51% respectively (P value = 0.25 95%CI -0.86 to 3.22). The mean % change in lean mass for the SG group and RYGB group was 9.4% and 10.49% respectively (P value = 0.38 95%CI -2.8 to 1.13).
Conclusions: Both the SG and RYGB provide equivalent, clinically significant loss in excess body weight. Despite the malabsorptive component of the RYGB, a greater degree of lean body mass loss was not observed when compared to the SG. This data can be used in patient counselling and patient selection when discussing the pros and cons of each procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93986
Program Number: P151
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster