title: Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study.
abstract: BACKGROUND
  Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program.
  
  
  METHODS
  We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data.
  
  
  RESULTS
  We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (-13.0 ± 6.6) than both the LSG (-7.6 ± 5.7) and the LAGB (-2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%.
  
  
  CONCLUSIONS
  In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe.
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Richdeep S
authors.initials: RS
authors.lastname: Gill
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Christian F
authors.initials: CF
authors.lastname: Rueda-Clausen
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Sameer
authors.initials: S
authors.lastname: Apte
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Birch
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.affiliation: From the Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alta. (Gill, Karmali); the Department of Medicine, University of Alberta, Edmonton, Alta. (Majumdar, Rueda-Clausen, Sharma, Klarenbach, Padwal); and the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte).
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D015431:Weight Loss