P Vasas1, S Nehemiah2, A Hussain2, J Finney2, K Kirk2, S Yeluri2, S Balchandra2. 1. Bariatric Surgery Centre, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, South Yorkshire, DN2 5LT, UK. peter.vasas@nhs.net. 2. Bariatric Surgery Centre, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, South Yorkshire, DN2 5LT, UK.
Abstract
BACKGROUND: The "perfect" bariatric procedure remains the topic of debate. The aim of this study is to compare the safety and outcome of laparoscopic Roux-en-Y gastric bypass (LRYGB) to those of laparoscopic sleeve gastrectomy (LSG) and adjustable gastric band (AGB) in a single centre, amongst those patients who made their own choice of which procedure they prefer. METHODS: After the multi-disciplinary team's assessment, the patients could make their own choice of procedures (self-selected, SS), unless medical/surgical conditions limited this (medically restricted, MR). All consecutive primary bariatric procedures were involved and reviewed between June 2010 and September 2014. The primary outcomes included 30-day complication and readmission rates, excess weight loss (%EWL) and co-morbidity resolution at 24 months postoperatively. RESULTS: A total of 303 patients were included and 271 of them made their own choice (SS 90%). One hundred eighty-three chose LRYGB (60.4%), and 57 underwent LSG (SS 45 and MR 12; overall 18.8%), with the initial BMI of 50.7 and 52.5 kg/m2, respectively. Sixty-two patients (SS 43, MR 19, overall 20%) underwent AGB, with a BMI of 52.1 kg/m2. Thirty-day complication rates for LRYGB and LSG were 10.2 and 2.9% (p < 0.05), and the readmission rates were 4.7 and 2.9%, respectively. %EWL for LRYGB was significantly higher than that of other procedures at 24 months (67.8 vs SS-sleeve 43.9%, MR-sleeve 47%, SS-band 33.8% and MR-band 36%; FU rate 94%). Diabetes remission was achieved in 31/50 patients in the LRYGB group (62%) and 2/9 patients (22%) in the LSG group. CONCLUSIONS: Self-selected bariatric procedures yield excellent weight loss and metabolic outcome. Providing an information-dense environment augments the choice of the right operation and could improve patients' compliance with weight loss surgery programmes.
BACKGROUND: The "perfect" bariatric procedure remains the topic of debate. The aim of this study is to compare the safety and outcome of laparoscopic Roux-en-Y gastric bypass (LRYGB) to those of laparoscopic sleeve gastrectomy (LSG) and adjustable gastric band (AGB) in a single centre, amongst those patients who made their own choice of which procedure they prefer. METHODS: After the multi-disciplinary team's assessment, the patients could make their own choice of procedures (self-selected, SS), unless medical/surgical conditions limited this (medically restricted, MR). All consecutive primary bariatric procedures were involved and reviewed between June 2010 and September 2014. The primary outcomes included 30-day complication and readmission rates, excess weight loss (%EWL) and co-morbidity resolution at 24 months postoperatively. RESULTS: A total of 303 patients were included and 271 of them made their own choice (SS 90%). One hundred eighty-three chose LRYGB (60.4%), and 57 underwent LSG (SS 45 and MR 12; overall 18.8%), with the initial BMI of 50.7 and 52.5 kg/m2, respectively. Sixty-two patients (SS 43, MR 19, overall 20%) underwent AGB, with a BMI of 52.1 kg/m2. Thirty-day complication rates for LRYGB and LSG were 10.2 and 2.9% (p < 0.05), and the readmission rates were 4.7 and 2.9%, respectively. %EWL for LRYGB was significantly higher than that of other procedures at 24 months (67.8 vs SS-sleeve 43.9%, MR-sleeve 47%, SS-band 33.8% and MR-band 36%; FU rate 94%). Diabetes remission was achieved in 31/50 patients in the LRYGB group (62%) and 2/9 patients (22%) in the LSG group. CONCLUSIONS: Self-selected bariatric procedures yield excellent weight loss and metabolic outcome. Providing an information-dense environment augments the choice of the right operation and could improve patients' compliance with weight loss surgery programmes.
Entities:
Keywords:
Bariatric surgery; Gastric bypass; Patient choice; Sleeve; Weight loss
Authors: Usha K Coblijn; Sjoerd M Lagarde; Christel A L de Raaff; Steve M de Castro; Willem F van Tets; H Jaap Bonjer; Bart A van Wagensveld Journal: Surg Obes Relat Dis Date: 2016-04-06 Impact factor: 4.734
Authors: James Yoon; Jingjing Sherman; Alexandra Argiroff; Edward Chin; Daniel Herron; William Inabnet; Subhash Kini; Scott Nguyen Journal: Obes Surg Date: 2016-11 Impact factor: 4.129
Authors: John B Buse; Sonia Caprio; William T Cefalu; Antonio Ceriello; Stefano Del Prato; Silvio E Inzucchi; Sue McLaughlin; Gordon L Phillips; R Paul Robertson; Francesco Rubino; Richard Kahn; M Sue Kirkman Journal: Diabetes Care Date: 2009-11 Impact factor: 19.112
Authors: Arezou Yaghoubian; Amy Tolan; Bruce E Stabile; Amy H Kaji; Gary Belzberg; Edward Mun; Robert Zane Journal: Am Surg Date: 2012-12 Impact factor: 0.688
Authors: Karen D Coulman; Noah Howes; James Hopkins; Katie Whale; Katy Chalmers; Sara Brookes; Alex Nicholson; Jelena Savovic; Yasmin Ferguson; Amanda Owen-Smith; Jane Blazeby; Jane Blazeby; Richard Welbourn; James Byrne; Jenny Donovan; Barnaby C Reeves; Sarah Wordsworth; Robert Andrews; Janice L Thompson; Graziella Mazza; Chris A Rogers Journal: Obes Surg Date: 2016-11 Impact factor: 4.129
Authors: Corey J Lager; Nazanene H Esfandiari; Angela R Subauste; Andrew T Kraftson; Morton B Brown; Ruth B Cassidy; Catherine K Nay; Amy L Lockwood; Oliver A Varban; Elif A Oral Journal: Obes Surg Date: 2017-01 Impact factor: 4.129
Authors: Chris A Rogers; Richard Welbourn; James Byrne; Jenny L Donovan; Barnaby C Reeves; Sarah Wordsworth; Robert Andrews; Janice L Thompson; Paul Roderick; David Mahon; Hamish Noble; Jamie Kelly; Graziella Mazza; Katie Pike; Sangeetha Paramasivan; Natalie Blencowe; Mary Perkins; Tanya Porter; Jane M Blazeby Journal: Trials Date: 2014-02-11 Impact factor: 2.279