Outcome of Bariatric Surgery in Thailand : Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-y Gastric Bypass

Pakkavuth Chanswangphuvana, MD, Soravith Vijitpornkul, MD, Ajjana Techagumpuch, MD, Suppa-ut Pungpapong, MD, Chadin Tharavej, MD, Patpong Navicharern, MD, Suthep Udomsawaengsup, MD. Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial University Hospital, Bangkok, Thailand.

Introduction
Obesity becomes a public health problem in Asia. Bariatric surgery has been accepted as a effective treatment. Laparoscopic roux-en-y gastric bypass (LRYGB) is one of the most widely used procedures, but laparoscopic sleeve gastrectomy (LSG) is increasing in popularity. However there is no study comparing both procedure in Thailand. Our objective is to evaluate the percentage of excess weight loss (%EWL), postoperative complication and mortality of the procedures.

Methods
A retrospective, group-matched controlled analysis was performed on 222 patients who underwent Bariatric Surgery in King Chulalongkorn Memorial University Hospital between 2003 and 2013. The patients in each procedure were matched for BMI.
Outcome measures were percentage of excess weight loss (%EWL), postoperative complication and mortality.

Results
80 patients performed either LSG or LRYGB with mean age 34.9 (9-60) years and mean BMI 51.9 (35.1-84.5). There were no operative-related mortality, no significant difference in postoperative complication (3.4% in LSG vs 6.4% in LRYGB, p=0.59). %EWL at 6 months of follow-up was analysed. Overall %EWL was significant difference (41.1% in LSG vs 59.5% in LRYGB, p<0.01). Subgroup analysis of BMI was done. %EWL of LRYGB were superior than of LSG only in BMI 35-44.9 group (72.92% in LRYGB vs 47.98% in LSG, p<0.01). In BMI 45-59.9 group and super obese group (BMI >60), weight loss was significant after LRYGB and LSG but there was no statistic difference at 6 months of follow-up.

Conclusion
In Thai population, laparoscopic roux-en-y gastric bypass achieved a significant higher excess weight loss when compared to laparoscopic sleeve gastrectomy only in BMI <45. However both procedures result in success weight loss with comparable complication and no mortality in all BMI group.

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