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Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB

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Abstract

Background

The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m2) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients.

Methods

Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted.

Results

The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m2. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%).

Conclusion

SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.

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Authors and Affiliations

  1. Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan

    Tien-Chou Soong

  2. Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan

    Tien-Chou Soong & Wei-Jei Lee

  3. College of Medicine, I-Shou University, Kaohsiung, Taiwan

    Tien-Chou Soong

  4. Metabolic & Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan

    Ming-Hsien Lee & Jung-Chien Chen

  5. Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan

    Wei-Jei Lee, Jung-Chien Chen, Chun-Chi Wu & Shu-Chun Chen

  6. Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia

    Owaid M. Almalki

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Correspondence to Wei-Jei Lee.

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Key Points

1. OAGB had a higher total weight loss (40.8%) than RYGB (37.2%) and SG (35.1%) at 5 years after surgery.

2. RYGB had a higher major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%) in super-obese patients.

3. SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%), but had a lower remission rate in dyslipidemia comparing to OAGB and RYGB.

4. OAGB had a similar operation risk to SG but resulted in a better weight loss than RYGB or SG.

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Soong, TC., Lee, MH., Lee, WJ. et al. Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB. OBES SURG 31, 3391–3399 (2021). https://doi.org/10.1007/s11695-021-05464-0

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  • DOI: https://doi.org/10.1007/s11695-021-05464-0

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