title: Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI ≥ 50 kg/m².
abstract: BACKGROUND
  Although laparoscopic sleeve gastrectomy (LSG) was initially described as the first step of a 2-stage procedure for high-risk patients requiring laparoscopic Roux-en-Y gastric bypass (LRYGB), it is now being used as a single-stage procedure. Experience with laparoscopic bariatric surgery is growing, such that LRYGB is increasingly feasible for patients with body mass index (BMI) ≥ 50 kg/m². Nevertheless, outcomes for such category of patients following LSG and LRYGB are lacking.
  
  
  OBJECTIVE
  To compare weight loss and changes in obesity related co-morbidities at one year following LSG with LRYGB in patients with BMI ≥ 50 kg/m².
  
  
  METHODS
  The prospective database of a single surgery university center was queried for clinical and other relevant data.
  
  
  METHODS
  From January 2004 to January 2013, 74 and 285 patients underwent LSG or LRYGB with a BMI ≥ 50 kg/m². At one year, rate of follow-up was 92.8%. Success of surgery was defined as % of excess weight loss (%EWL)≥ 50% at one year. Logistic regression was used to compute odds ratio (OR) to evaluate the success at one year of surgery.
  
  
  RESULTS
  LSG (N = 74) and LGBP (N = 285) groups did not differ for initial BMI (57.2 ± 7.1 versus 56.7 ± 5.5 kg/m²; P = .52), % of female (64.6% versus 73.7%, P = .13) or major adverse postoperative events (5.7% versus 6.7%; P = .85). At one year, the mean percentage of weight loss (%) (22.0 ± 7.6 versus 30.3 ± 7.4; P < .0001) and percentage of excess weight loss (%) (40.2 ± 15.2 versus 55.0 ± 14.6; P < .0001) and rates of remission of diabetes (47.5% versus 70.7%; P = .01) were greater in the LGBP than LSG group. In multivariate analyses (OR), LSG was an independent factor of failure of weight loss (.12; P < .0001) CONCLUSION: After 1 year of follow-up in patients with a BMI ≥ 50 kg/m², LRYGB provides better weight loss and resolution in diabetes than LSG with similar postoperative morbidity. Further long-term studies are needed to confirm these results.
authors.affiliation: Department of General, Digestive and Metabolic Surgery, the Department of Nutrition. Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.affiliation: Department of General, Digestive and Metabolic Surgery, the Department of Nutrition. Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: Corigliano
authors.affiliation: Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Centre Île-de-France (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Poitou
authors.affiliation: Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Centre Île-de-France (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Oppert
authors.affiliation: Department of General, Digestive and Metabolic Surgery, the Department of Nutrition. Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France; Centre for Epidemiologic Cohort in Population (INSERM UMS 011), Villejuif, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Czernichow
authors.affiliation: Department of General, Digestive and Metabolic Surgery, the Department of Nutrition. Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France. Electronic address: jl.bouillot@apr.aphp.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bouillot
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
keywords: Bariatric surgery; Gastric bypass; Sleeve gastrectomy; Super obesity; Super-super obesity