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
Open accessAbstract
OBJECTIVE: To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) as compared to the laparoscopic adjustable gastric band (LAGB), the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the open Roux-en-Y gastric bypass (ORYGB) for the treatment of obesity and obesity-related diseases. BACKGROUND: LSG is a newer procedure being done with increasing frequency. However, limited data are currently available comparing LSG to the other established procedures. We present the first prospective, multiinstitutional, nationwide, clinically rich, bariatric-specific data comparing sleeve gastrectomy to the adjustable gastric band, and the gastric bypass. METHODS: This is the initial report analyzing data from the American College of Surgeons-Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and 1-year outcomes including morbidity and mortality, readmissions, and reoperations as well as reduction in body mass index (BMI) and weight-related comorbidities. RESULTS: One hundred nine hospitals submitted data for 28,616 patients, from July, 2007 to September, 2010. The LSG has higher risk-adjusted morbidity, readmission and reoperation/intervention rates compared to the LAGB, but lower reoperation/intervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB. CONCLUSION: LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined.
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Calcium malabsorption has been documented as early as 3 months after RYGB, with reduced true fractional calcium absorption and secondary hyperparathyroidism.
“Calcium malabsorption has been documented as early as 3 months after RYGB53, 54 with reduced true fractional absorption of calcium57, and secondary hyperparathyroidism52, 53, 58, 59.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
After RYGB, patients typically lose 35% of initial weight or 62-75% of excess body weight, significantly more than with gastric banding.
“After RYGB, patients typically lose 35% of initial weight, or 62-75% of excess body weight47, 52-54, significantly greater than with GB.55, 56.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
Resorption markers increase steadily by up to 200% over the first 12-18 months after RYGB.
“Resorption markers increase steadily by up to 200% over the first 12-18 months 52, 63, 64.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
A strong association between extent of weight loss after bariatric surgery and amount of bone loss has been documented by most but not all studies.
“A strong association between extent of weight loss after bariatric surgery and amount of bone loss has been documented bymost40, 45, 51-53, 62, 67 but not all studies.63”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
Spine BMD changes after RYGB are variable, with some studies reporting small decreases and others not.
“Changes at the spine are more variable, some studies report small decreases 24, 54, 63, 67-69, while others have not 52, 53, 65, 66.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
RYGB subjects typically lose more weight and more bone at the hip and femoral neck at one year than those who undergo gastric banding or vertical banded gastroplasty.
“Typically, RYGB subjects lose more weight and more bone at the hip and FN at one year than those who undergo GB44, 52 or VBG.72.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
The HR-pQCT finding of pronounced changes at the tibia but not the radius suggests an interaction between PTH and weight bearing.
“Our HR-pQCT study demonstrating pronounced changes at the tibia but not the radius, suggests that there may be an interaction between PTH and weight bearing52.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
Hip BMD declines after RYGB range between 8% and 11%.
“Declines in hip BMD range between 8-11%17, 52-54, 62, 67-69.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
Increased PTH is associated with greater femoral neck bone loss and cortical bone loss at the tibia.
“PTH may affect hip bone loss as well; with increased PTH associated with greater bone loss at the FN53 and with cortical bone loss at the tibia 52 (Figure 3).”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
Subjects with increased or stable 25OHD had less femoral neck bone loss than those whose 25OHD declined.
“Subjects with increased or stable 25OHD had less bone loss at the FN than those whose 25OHD declined, suggesting that postoperative maintenance of 25OHD stores is important to hip bone preservation52.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [52]
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- Authors
- Hutter, M. M., Schirmer, B. D., Jones, D. B., Ko, C. Y., Cohen, M. E., Merkow, R. P., & Nguyen, N. T.
- Affiliations
- Massachusetts General Hospital (US)
- University of Virginia Health System (US)
- Beth Israel Deaconess Medical Center (US)
- University of California, Los Angeles (US)
- American College of Surgeons (US)
- University of California, Irvine (US)
- Corresponding author
- Hutter, Matthew M.
- Merkow, Ryan P.
- Venue
- Annals of Surgery
- Published
- 2011-09
- Volume
- 254
- Issue
- 3
- Pages
- 410-422
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC3339264
- OpenAlex
- W2072882958
- Cited by
- 673
- References
- 28
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 37 · 2023: 20 · 2022: 21 · 2021: 34 · 2020: 49 · 2019: 48 · 2018: 71 · 2017: 51 · 2016: 68 · 2015: 72 · 2014: 90 · 2013: 54 · 2012: 27
- FWCI
- 56.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Biomedical Imaging and Bioengineering (R01EB009362, R01EB005807)
- 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
- laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric band, laparoscopic Roux-en-Y gastric bypass, bariatric surgery, obesity, obesity-related comorbidities, postoperative morbidity, hospital readmission, reoperation, mortality, body mass index reduction, comparative effectiveness
- MeSH terms
- Accreditation, Analysis of Variance, Female, Follow-Up Studies, Gastrectomy, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Prospective Studies, Risk Factors, Societies, Medical, United States, Gastric Bypass, Gastroplasty, Weight Loss, Body Mass Index, Multivariate Analysis, Treatment Outcome, Practice Guidelines as Topic, Risk Assessment, Bariatric Surgery
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