Yonsei Med J.  2016 Jul;57(4):956-962. 10.3349/ymj.2016.57.4.956.

Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients

Affiliations
  • 1Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Department of Surgery, School of Medicine, Inha University, Incheon, Korea. gshur@inha.ac.kr
  • 3National Evidence-based Healthcare Collaborating Agency, Seoul, Korea. jylee@neca.re.kr
  • 4Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 5Department of Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea.
  • 6Department of Surgery, Gachon University College of Medicine, Incheon, Korea.
  • 7Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 8Department of Surgery, CHA University School of Medicine, Seoul, Korea.
  • 9Department of Family Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
  • 10Department of Family Medicine, School of Medicine, Inha University, Incheon, Korea.
  • 11College of Pharmacy, Kyungpook National University, Daegu, Korea.

Abstract

PURPOSE
Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults.
MATERIALS AND METHODS
In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated.
RESULTS
In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia.
CONCLUSION
The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group.

Keyword

Morbid obesity; bariatric surgery; outcomes; comparative study; Koreans

MeSH Terms

Adult
Cohort Studies
Comorbidity
Female
*Gastrectomy/adverse effects
*Gastric Bypass/adverse effects
Humans
Male
Obesity, Morbid/epidemiology/*surgery
Republic of Korea
Retrospective Studies
Treatment Outcome
Weight Loss

Figure

  • Fig. 1 (A) Comparison of percentage of weight loss (%WL) over an 18-month follow-up. (B) Comparison of percentage of excess weight loss (%EWL) over an 18-month follow-up. %WL, percentage of weight loss; %EWL, percentage of excess weight loss; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; SG, sleeve gastrectomy.


Reference

1. Ministry of Health and Welfare. Ministry of Health and Welfare statistical year book. Seoul: Ministry of Health and Welfare;2013. p. 10–11.
2. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004; 351:2683–2693.
Article
3. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014; 311:2297–2304.
Article
4. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013; 23:427–436.
Article
5. Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011; 254:410–420.
6. Lee SK. Current status of laparoscopic metabolic/bariatric surgery in Korea. J Minim Invasive Surg. 2015; 18:59–62.
Article
7. 1983 metropolitan height and weight tables. Stat Bull Metrop Life Found. 1983; 64:3–9.
8. Heo YS, Park JM, Kim YJ, Kim SM, Park DJ, Lee SK, et al. Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study. J Korean Surg Soc. 2012; 83:335–342.
Article
9. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005; 15:1469–1475.
Article
10. Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004; 135:326–351.
Article
11. Cottam DR, Atkinson J, Anderson A, Grace B, Fisher B. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006; 16:534–540.
Article
12. Chouillard EK, Karaa A, Elkhoury M, Greco VJ. Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS). Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study. Surg Obes Relat Dis. 2011; 7:500–505.
Article
13. Chakravarty PD, McLaughlin E, Whittaker D, Byrne E, Cowan E, Xu K, et al. Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the randomised controlled trials. Surgeon. 2012; 10:172–182.
Article
14. Trastulli S, Desiderio J, Guarino S, Cirocchi R, Scalercio V, Noya G, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013; 9:816–829.
Article
15. Campos GM, Rabl C, Roll GR, Peeva S, Prado K, Smith J, et al. Better weight loss, resolution of diabetes, and quality of life for laparoscopic gastric bypass vs banding: results of a 2-cohort pair-matched study. Arch Surg. 2011; 146:149–155.
Article
16. Angrisani L, Cutolo PP, Formisano G, Nosso G, Vitolo G. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis. 2013; 9:405–413.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr