title: Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy.
abstract: BACKGROUND
  Bariatric surgery is associated with improved co-morbidities, quality of life, and survival in severely obese patients. Common bariatric surgery procedures include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and sleeve gastrectomy (SG). Currently, literature studying comparative effectiveness on different bariatric surgery procedures in veterans is limited.
  
  
  OBJECTIVE
  To compare effectiveness of 3 bariatric surgery procedures performed in veterans.
  
  
  METHODS
  Veterans Affairs Loma Linda Healthcare Systems (VALLHS), Loma Linda, California, United States.
  
  
  METHODS
  This study was a single-institution, retrospective cohort study. Primary outcome was weight reduction, expressed as kilograms lost, body mass index (BMI) reduction, percentage weight loss (%WL), and percentage excess weight loss (%EWL) after 12 months of bariatric surgery. Secondary outcomes were reduction in number of medications and laboratory markers for obesity-related chronic conditions. Inverse-probability weighting propensity score method was used to balance baseline characteristics among the procedures.
  
  
  RESULTS
  A total of 162 patients were included in the study. At 12 months, the kilograms lost, BMI reduction, %WL, and %EWL were 40.7±14.5 kg, 13.4±4.1 kg/m(2), 31.5±8.5%, and 41.4±11.6% for RYGB; 24.4±22.1 kg, 7.9±7.3 kg/m(2), 20.2±21.5%, and 26.7±27.6% for SG; and 15.3±15.7 kg, 5.0±5.0 kg/m(2), 12.0±11.7%, and 16.1±15.9% for LAGB, respectively (RYGB versus SG, RYGB versus LAGB, and SG versus LAGB, all P<.01). The reduction in number of medications, total cholesterol, and low-density lipoprotein (LDL) also showed significant improvement with RYGB.
  
  
  CONCLUSIONS
  For the short term, RYGB appears to achieve better weight reduction and management of obesity-associated co-morbid conditions compared with the SG and LAGB procedures in veteran patients. SG could be the next alternative over LAGB for the bariatric surgery procedure in patients who are not candidates for RYGB.
authors.affiliation: Western University of Health Sciences, Pomona, California.
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Veterans Affairs Loma Linda Health Systems, Loma Linda, California.
authors.forename: Quynh-Nhu
authors.initials: QN
authors.lastname: Nguyen
authors.affiliation: Western University of Health Sciences, Pomona, California; Veterans Affairs Loma Linda Health Systems, Loma Linda, California. Electronic address: qle@westernu.edu.
authors.forename: Quang A
authors.initials: QA
authors.lastname: Le
mesh_terms: D000704:Analysis of Variance; D015992:Body Mass Index; D002140:California; D005260:Female; D005743:Gastrectomy / Q000592:standards*; D015390:Gastric Bypass / Q000592:standards*; D015391:Gastroplasty / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Bariatric surgery procedures; Comparative effectiveness; Laparoscopic adjustable gastric band; Roux-en-Y gastric bypass; Sleeve gastrectomy; US veterans