Tailoring Bariatric Surgery: Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch
Abstract
BACKGROUND: A need exists to select the most appropriate bariatric operation for a particular patient. One-year data comparing sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS) are sparse. METHODS: The Bariatric Outcomes Longitudinal Database was queried from June 2007 to September 2011 for 30-day and 1-year adverse events, and 1-year weight loss and comorbidity resolution. Propensity scores with inverse probability weighting were used to match for age, gender, body mass index (BMI), ethnicity, and select comorbidities. Multivariate linear and logistic regressions estimated differences and odds ratios (ORs), respectively, for each pairwise bariatric operation comparison. RESULTS: Among 73,702 subjects, 5942 patients underwent SG, 66,324 patients underwent RYGB, and 1436 patients underwent BPD/DS. Compared with SG, decrease in BMI units was greater by 5.3 for BPD/DS and by 2.2 U for RYGB at 1 year. Resolution of gastroesophageal reflux disease (GERD) was best for RYGB (OR = 1.88, 95% confidence interval [CI]: 1.73-2.03) and still good for BPD/DS (OR = 1.57, 95% CI: 1.29-1.90). Hypertension and diabetes mellitus (DM) resolution were better after BPD/DS (OR = 2.12, 95% CI: 1.83-1.64, and OR = 2.53, 95% CI: 2.13-3.00, respectively) and for RYGB were (OR = 1.54, 95% CI: 44-1.64 and OR = 1.63, 95% CI: 1.51-1.75, respectively). Odds of serious adverse events at 1 year were: RYGB, OR = 1.70, 95% CI: 1.45-2.00; BPD/DS, OR = 4.31, 95% CI: 3.06-6.07. CONCLUSIONS: Using SG as reference, RYGB was associated with highest resolution of GERD, whereas BPD/DS was associated with highest resolution of DM and hypertension. These findings can guide decision making regarding choice of bariatric operation.
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A matched cohort study on 73,702 patients from the Bariatric Outcomes Longitudinal Database reported BPD/DS to be associated with the greatest adjusted change in BMI compared to RYGB and sleeve gastrectomy.
“A matched cohort study on 73,702 patients from the Bariatric Outcomes Longitudinal Database reported BPD/DS to be associated with the greatest adjusted change in BMI compared to RYGB and sleeve gastrectomy.”
From Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP (2020) · cites this paper as [111]
The matched cohort study also suggested that BPD/DS was superior in terms of diabetes remission.
“The study also suggested that BPD/DS was superior in terms of diabetes remission [111].”
From Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP (2020) · cites this paper as [111]
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- Authors
- Sudan, R., & Jain-Spangler, K.
- Affiliations
- Duke Medical Center (US)
- Corresponding author
- Sudan, Ranjan
- Venue
- Journal of Laparoendoscopic & Advanced Surgical Techniques
- Publisher
- SAGE Publications
- Published
- 2018-08
- Volume
- 28
- Issue
- 8
- Pages
- 956-961
- ISSN
- 1092-6429 (ISSN-L)
- 1557-9034
- OpenAlex
- W2886551616
- Cited by
- 34
- References
- 12
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 1
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Laparoendoscopic & Advanced Surgical Techniques (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- bariatric surgery, sleeve gastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch, obesity, weight loss, comorbidity resolution, gastroesophageal reflux disease, hypertension, diabetes mellitus, postoperative complications, surgical site infection, revisional surgery, patient selection, long-term outcomes
- MeSH terms
- Adult, Female, Gastrectomy, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Morbid, Postoperative Complications, Gastric Bypass, Weight Loss, Comorbidity, Biliopancreatic Diversion, Logistic Models, Databases, Factual, Treatment Outcome, Propensity Score
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