Takeshi Naitoh, MD1, K Kasama, MD2, Y Seki, MD2, M Ohta, MD3, T Oshiro, MD4, A Sasaki5, Y Miyazaki, MD6, T Yamaguchi, MD7, H Hayashi, MD8, N Tanaka, MD1, H Imoto, MD1, M Unno, MD1. 1Department of Surgery, Tohoku University Graduate School of Medicine, 2Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 3Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 4Department of Surgery, Toho University Medical Center, Sakura Hospital, 5Department of Surgery, Iwate Medical University School of Medicine, 6Department of Surgery, Osaka University Graduate School of Medicine, 7Department of Surgery, Shiga University of Medical Science, 8Research Center for Frontier Medical Engineering, Chiba University
Background: Body weight loss after bariatric surgery is affected by several factors. Diabetes status or preoperative body mass index (BMI) would affect the body weight loss after surgery. Age and sexuality may also be the predictor. Furthermore, the malabsorptive procedure is considered more effective for body weight loss than the restrictive procedure alone. We investigated the contribution of preoperative background data and procedures to the body weight loss after surgery.
Methods: This was a multicenter, retrospective study to validate the efficacy of bariatric surgery for morbidly obese patients in Japan. Patients underwent sleeve gastrectomy (LSG) or LSG with duodenal-jejunal bypass (LSG/DJB) in each institution from January 2005 to December 2015, and whose BMI was 35kg/m2 or more at the first visit were included in this study. We investigated the percent excess body weight loss (%EWL) at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of body weight loss. We defined that %EWL more than 50% as Well Response (WR). Procedures, age, sex, diabetes status including insulin use, and BMI at first visit was collected as predictive factors for body weight loss.
Results: Data from 565 cases, including 420 cases of LSG and 145 cases of LSG/DJB, were analyzed. The male to female ratio was 252:313. Mean body weight at first visit was 122.9kg and mean BMI was 45.0kg/m2. No mortality was observed and Clavien-Dindo grade III or more postoperative complications occurred in 20 cases (3.5%). Of those, 430 cases achieved WR (76.1%). In overall patients, WR rate was significantly higher in patients without diabetes (81.0%) and BMI≤50kg/m2 (80.4%), while procedure, sex, and age were not affected to WR rate. However, among patients with diabetes, the procedure and BMI≤50kg/m2 was significant factors affected to WR rate in univariate analysis, and the following multivariate analysis revealed that LSG/DJB (OR: 2.04, 95%CI: 1.16-3.59), no insulin use (OR: 1.84, 95%CI: 1.01-3.36), and BMI≤50kg/m2 (OR: 2.97, 95%CI: 1.62-5.43) were significant predictive factors for WR. Moreover, among patients both with diabetes and BMI>50kg/m2, the LSG/DJB was the only predictive factor for WR (OR: 2.99, 95%CI: 1.01-8.91).
Conclusion: In Japanese obese patients, both LSG and LSG/DJB work effectively for excess body weight loss. However, patients with diabetes or BMI>50kg/m2 were the poor prognostic factors. For those with diabetes and BMI>50kg/m2, LSG/DJB would be more effective than LSG alone.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86602
Program Number: P576
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster