Richdeep S Gill, MD, PhD1, Sameer Apte, MD2, Sumit R Majumdar, MD2, Calypse Agborsangaya2, Christian F Rueda-Clausen, MD2, Daniel W Birch, MD1, Shahzeer Karmali, MD1, Scott Klarenbach, MD2, Arya Sharma, MD2, Raj Padwal, MD2. 1Center of the Advancement of Minimally Invasive Surgery (CAMIS), 2University of Albeta
Background: Bariatric care is increasingly being delivered in Canada within publicly funded regional programs. The optimal bariatric surgical procedure for severely obese individuals receiving bariatric care is currently unknown. The objective of this population-based prospective cohort study was to compare the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in severely obese patients.
Methods: 150 consecutive patients (51 LRYGB; 51 LSG; 48 LAGB) from the population-representative, publicly funded Edmonton Weight Wise bariatric program were examined. The primary outcome was weight change (kg). Between-group changes were analyzed using multivariable regression adjusted for age, sex, and baseline weight. Last-observation-carried-forward imputation was used for missing data.
Results: At baseline, mean age was 43.5±9.5 years, 87.3% were females and overall preoperative BMI was 46.2±7.4 kg/m2. Absolute (kg) and relative (% of baseline) mean weight losses were 36.6±19.5kg (26.1±12.2%) for LRYGB, 21.4±16.0kg (16.4±11.6%) in for LSG, and 7.0±9.7kg (5.8±7.9%) for LAGB (p<0.0001 for between-group comparisons) at 2-years. Change in BMI was significantly greater in the LRYGB (-13.0±6.6 kg/m2) group compared to both the LSG (-7.6±5.7 kg/m2) and the LAGB (-2.6±3.5 kg/m2) groups (p<0.0001 for between-group comparisons). In addition, change in BMI was significantly greater in the LSG group compared to the LAGB group (p<0.05). Hypertension, diabetes, and dyslipidemia prevalence’s decreased to a significantly greater degree with LRYGB compared to LAGB (p<0.05).
Conclusion: In a publicly funded bariatric surgery program providing population-based bariatric care to severely obese individuals, LRYGB and LSG demonstrated greater weight loss than LAGB. LRYGB was more effective than LAGB in improving obesity-related comorbidities.