Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters.
BACKGROUND
Bariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity. Aim of this study was to compare the long-term effects of malabsorptive (biliary pancreatic diversion, BPD), and restrictive (laparoscopic gastric banding, LAGB) procedures on metabolic and cardiovascular parameters, as well as on metabolic syndrome in morbidly obese patients.


METHODS
170 patients studied between 1989 and 2001 were called back after a mean period of 65 months. 138 patients undergoing BPD (n=23) or LAGB (n=78), and control patients (refusing surgery and treated with diet, n=37) were analysed for body mass index (BMI), blood glucose, cholesterol, and triglycerides, blood pressure, heart rate, and ECG indexes (QTc, Cornell voltage-duration product, and rate-pressure-product).


RESULTS
After a mean 65 months period, surgery was more effective than diet on all items under evaluation; diabetes, hypertension, and metabolic syndrome disappeared more in surgery than in control patients, and new cases appeared only in controls. BPD was more effective than LAGB on BMI, on almost all cardiovascular parameters, and on cholesterol, not on triglyceride and blood glucose. Disappearance of diabetes, hypertension, and metabolic syndrome was similar with BPD and with LAGB, and no new cases were observed.


CONCLUSIONS
These data indicate that BPD, likely due to a greater BMI decrease, is more effective than LAGB in improving cardiovascular parameters, and similar to LAGB on metabolic parameters, in obese patients. The greater effect on cholesterol levels is probably due to the different mechanism of action.
Pontiroli
Antonio E
AE
Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Ospedale San Paolo, Milano, Italy. antonio.pontiroli@unimi.it
Laneri
Marco
M
Veronelli
Annamaria
A
Frigè
Francesca
F
Micheletto
Giancarlo
G
Folli
Franco
F
Adami
Gianfranco
G
Scopinaro
Nicola
N
D000328:Adult; D050110:Bariatric Surgery; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D010535:Laparoscopy; D008286:Malabsorption Syndromes / Q000097:blood* / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000178:diet therapy / Q000601:surgery; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
D001786:Blood Glucose; D014280:Triglycerides; D002784:Cholesterol