“a Prospective Comparison of Laparoscopic Sleeve Gastrectomy and Gastric Bypass”

Francesco Stipa, MD PhD FACS, Valentina Giaccaglia, MD, Alessio Pigazzi, MD FACS, Antonio Burza, MD, Ettore Santini, MD. Department of Surgery, San Giovanni Hospital, Rome, Italy

Background. The aim of this study was to compare the effect on comorbidities and failure rates of two common bariatric surgical procedures performed laparoscopically: sleeve gastrectomy (SG) and gastric bypass (GBP), to define whether one operation is superior.

Methods. Between 2006 and 2011 we operated on 120 morbidly obese patients, performing SG (n=60) and GBP (n=60). The choice of the operation was based on patient/surgeon discussion. The analyses included the following variables: age, sex, body mass index (BMI), dietary history, the presence of eating disorder and comorbidities (depression, diabetes, gastroesophageal reflux, hypertension, obstructive sleep apnoea, hyperlipidemia, joint disease). The percentage of estimated weight loss (EWL) was assessed. The mean follow up was 30 months.

Results. In the two groups the mean preoperative and postoperative BMI were the following: SG group (mean age = 40) 44.5 and 32.8; GBP group (mean age = 43): 45.3 and 32.5. The %EWL for SG was 57.5% and for GBP 57.1% (p =0.65, NS ). Men responded slightly better than women with %EWL of 55.5% vs 53.7% respectively (p =0.048). Failure rates were 0% for SG and 5% for GBP (p =0.014). Resolution of comorbidities were 75% for SG and 85% for GBP (p = 0.044).

Conclusions. In our experience SG and GBP have similar short term effects. A longer follow up is necessary to confirm these results over a longer period of time. SG is technically simpler than GBP and may become the most common bariatric operation.