Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass: A Retrospective Review of Weight-loss and Resolution of Co-morbidities

Alisha Skinner, BA, Brent Tatsuno, BS, Yosuke Mitsugi, MD, Edwin A Takahashi, BS, Michael Tom, BA, James Davis, PhD, Daniel Murariu, MD MPH, Racquel S Bueno, MD FACS, Cedric S Lorenzo, MD. University of Hawaii John A. Burns School of Medicine, University of Hawaii Department of Surgery, Kuakini Medical Center, The Queen’s Medical Center, Honolulu, Hawaii, United States of America

 Background: The outcomes for laparoscopic roux-en-y gastric bypass surgery versus laparoscopic sleeve gastrectomy for weight loss and co-morbidities resolution were compared. Laparoscopic roux-en-y gastric bypass surgery (LRYGB) has become the leading procedure for weight loss in the morbidly obese. Multiple obesity related co-morbidities including type 2 diabetes mellitus (T2DM), hypertension (HTN), obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) improve or resolve following these operations. LRYGB has been the primary surgery offered to bariatric patients, but the laparoscopic sleeve gastrectomy (LSG) is an increasingly popular alternative procedure.

Methods: A retrospective chart review at a bariatric center associated with a tertiary medical center was conducted to analyze the quantity of excess weight loss (EWL) and the resolution of T2DM, HTN, OSA, and GERD in 26 patients undergoing LRYGB and 26 patients undergoing LSG between 01/01/2008 and 2/8/2010. Subjects were matched primarily based on age, gender, pre-operative weight and BMI, and secondarily on co-morbidities. Statistical analysis was performed using McNemar’s test for categorical variables and paired t test for continuous variables.

Results: At one year after surgery, the LRYGB operative subjects had an EWL of 84.2% compared to 66.1% for the LSG group (p<0.01). T2DM had resolved respectively in 93% and 75% of LRYGB and LSG patients (p=0.53). HTN had resolved respectively in 45% and 56% of LRYGB and LSG patients (p=0.74). CPAP use for OSA had resolved respectively in 77% and 62% of LRYGB and LSG patients (p=0.67), while the diagnosis of GERD had resolved in 56% and 56% (p=1.00).

Conclusions: Our data shows a significantly greater percentage of EWL at one year in patients undergoing LRYGB compared to LSG. There was a significant resolution of co-morbidities associated with obesity in both groups, but without a significant difference between them. Our results confirm that LSG is a viable alternative to LRYGB in the resolution of obesity related co-morbidities, despite greater weight loss obtained in the LRYGB group.

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