Comparison of changes in lipid profile after bilio-intestinal bypass and gastric banding in patients with morbid obesity.
BACKGROUND
The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery.


METHODS
We prospectively investigated the effects of the bilio-intestinal bypass (BI-bypass) with a wide cholecysto-jejunal anastomosis and of adjustable gastric banding (AGB) on blood lipid concentrations in obese patients. To clarify the mechanism of the hypocholesterolemic effect of the BI-bypass, daily fecal sterol excretion was measured by gas-liquid chromatography (GLC).


RESULTS
At 1 year after BI-bypass compared to baseline, the hypercholesterolemic (n=18) and the normocholesterolemic (n=19) patients significantly reduced total (-38% and -27%, respectively), LDL (-47% and -24%, respectively) and HDL (-11% and -13%, respectively) cholesterol and total / HDL cholesterol ratio (-25% and -13%, respectively). At 1 year after AGB, the total / HDL cholesterol ratio was significantly decreased (-11%) compared to baseline in hypercholesterolemic (n=12) but not in normocholesterolemic (n=6) patients, while total and LDL cholesterol were not affected in both groups. At 3 years after BI-bypass compared to baseline, the hypercholesterolemic (n=9) and the normocholesterolemic (n=11) patients significantly reduced total (-43% and -28%, respectively) and LDL (-53% and -29%, respectively) cholesterol and total / HDL cholesterol ratio (-38% and -21%, respectively). The BI-bypass induced a significant (P <0.005; n=7) 6-fold increase in mean fecal cholesterol output.


CONCLUSIONS
The BI-bypass but not the AGB leads to a persistent and marked beneficial effect on blood LDL cholesterol associated with an increased cholesterol fecal output. BI-bypass but not AGB is indicated in morbidly obese patients with hypercholesterolemia.
Corradini
Stefano Ginanni
SG
Dipartimento di Medicina Clinica Divisione di Gastroenterologia, Italy. stefano.corradini@uniroma1.it
Eramo
Annarita
A
Lubrano
Carla
C
Spera
Giovanni
G
Cornoldi
Alessandra
A
Grossi
Antonio
A
Liguori
Francesca
F
Siciliano
Maria
M
Pisanelli
Massimo Codacci
MC
Salen
Gerald
G
Batta
Ashok Kumir
AK
Attili
Adolfo Francesco
AF
Badiali
Marco
M
D000328:Adult; D001647:Bile Acids and Salts / Q000032:analysis; D015904:Biliopancreatic Diversion / Q000379:methods*; D004083:Cholestanol / Q000032:analysis; D002784:Cholesterol / Q000032:analysis / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005243:Feces / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000628:therapy; D007581:Jejunoileal Bypass / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D010840:Phytosterols / Q000032:analysis; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood
D001647:Bile Acids and Salts; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D010840:Phytosterols; D014280:Triglycerides; D004083:Cholestanol; D002784:Cholesterol