Home Medizin Der Magenbypass zeigt in einer Langzeitstudie eine leichte Edge-over-Sleeve-Gastrektomie

Der Magenbypass zeigt in einer Langzeitstudie eine leichte Edge-over-Sleeve-Gastrektomie

von NFI Redaktion

In a recently published Phase III randomized controlled trial (RCT) in The Lancet Regional Health – Europe, researchers from the Netherlands investigated and compared the long-term weight loss effects of a sleeve gastrectomy and a Roux-en-Y gastric bypass in people with obesity.

They found that both procedures exhibited clinically comparable excessive reduction in body mass index (BMI) in individuals with grade 2 and 3 obesity.

Furthermore, they found that the Roux-en-Y gastric bypass led to significantly higher total weight loss (TWL) and showed advantages in conditions such as dyslipidemia and gastroesophageal reflux disease (GERD).


Study: Long-term effects of sleeve gastrectomy compared to Roux-en-Y gastric bypass in people with severe obesity: A multicenter, randomized, controlled phase-III trial (SleeveBypass). Image source: Shidlovski/Shutterstock.com











Study:
Long-term effects of sleeve gastrectomy compared to Roux-en-Y gastric bypass in people with severe obesity: A multicenter, randomized, controlled phase-III study (SleeveBypass).
Image source: Shidlovski/Shutterstock.com

Background

Obesity, a global health issue, has experienced an alarming increase, highlighting the need for effective treatments. Metabolic surgeries like Roux-en-Y gastric bypass and sleeve gastrectomy have proven to be highly effective interventions.

Previous studies and reviews comparing the two procedures, however, showed contradictory results, with potential benefits for Roux-en-Y gastric bypass in terms of weight loss and remission of type 2 diabetes (T2D).

Sleeve gastrectomy is less complex and more commonly performed. Although it may be beneficial in terms of health-related quality of life (HRQoL), concerns about its irreversibility and potential risk of GERD persist.

Given the current uncertainty in this regard, the researchers in this study aimed to evaluate the clinical comparability between sleeve gastrectomy and Roux-en-Y gastric bypass, providing further insights in this field.

About the Study

The study (SleeveBypass) was conducted as a Phase-III RCT in two Dutch hospitals. Patients eligible for metabolic surgery (n = 628) were randomized in a 1:1 ratio and received either a sleeve gastrectomy (n = 312) or a Roux-en-Y gastric bypass (n = 316).

During the study, there was a crossover where procedures were switched in 13 and 16 patients originally assigned to sleeve gastrectomy and Roux-en-Y gastric bypass, respectively. The average age of the patients was 43 years, and their baseline BMI was 43.5 kg/m2, with 81.8% of them being female.

Patients with severe GERD, hiatus hernia, previous metabolic or major abdominal surgery, and inability to provide informed consent were excluded.

Stratification of patients occurred based on gender, T2D, and BMI. Surgical interventions followed specific protocols, and the patients adhered to the „Enhanced Recovery After Bariatric Surgery“ protocol.

The primary outcome of the study was weight loss based on the percentage of excess BMI loss after five years post-operation. Secondary endpoints included total weight loss, resolution of comorbidity, operation duration, hospital stay, additional clinical visits, morbidity and mortality within 30 days, need for revision surgery, and HRQoL.

Measurements were collected up to five years postoperatively. The statistical analysis included the use of linear mixed models, Chi-squared test, exact Fisher test, multivariable logistic regression, unpaired Student’s t-test, nonparametric Mann-Whitney U test, and multiple imputation methods.

Results and Discussion

Approximately 34.1% of participants had hypertension, 18.5% had T2D, 21.7% had dyslipidemia, 15.4% had obstructive sleep apnea (OSA), and 23.1% experienced severe joint pain at the start of the study.

The mean excessive BMI loss was higher after Roux-en-Y gastric bypass (67.1%) compared to sleeve gastrectomy (58.8%). However, the difference between the two groups (8.3%) was within the equivalence margin.

Five years post-operation, sleeve gastrectomy resulted in a TWL of 22.5%, while Roux-en-Y gastric bypass led to a higher TWL of 26%. Both procedures showed a significant improvement in obesity-related comorbidities after five years.

It was observed, however, that dyslipidemia improved more significantly with Roux-en-Y gastric bypass (83%) compared to sleeve gastrectomy (62%, P = 0.006). Additionally, de novo gastroesophageal reflux disease occurred more frequently with sleeve gastrectomy (16%) compared to Roux-en-Y gastric bypass (4%, P < 0.001).

Although minor complications were more frequent with Roux-en-Y gastric bypass than with sleeve gastrectomy, the differences between the two groups in terms of serious complications, hypertension, T2D, OSA, joint pain, and HRQoL were statistically insignificant.

This is the largest study comparing Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of obesity. However, it is limited due to a relatively wider equivalence margin, a lack of consideration of the impact of baseline BMI on BMI loss, and potential selection bias.

Conclusion

In conclusion, the results of the SleeveBypass study support the use of metabolic surgery for the treatment of obesity and provide clearer insights into the benefits and drawbacks of sleeve gastrectomy and Roux-en-Y gastric bypass.

The study provides valuable evidence that may assist clinicians and policymakers in making informed decisions, potentially leading to improved public health outcomes.

Related Posts

Adblock Detected

Please support us by disabling your AdBlocker extension from your browsers for our website.