Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study.

摘要

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is gaining popularity as a procedure for the treatment of morbid obesity and type 2 diabetes mellitus. Either as a first-stage procedure for superobese patients or as a definitive procedure, SG is becoming the first-choice bariatric procedure in France. Preliminary results have suggested that the weight loss and resolution of co-morbidities with SG could be comparable to those with laparoscopic Roux-en-Y gastric bypass (RYGB). In a multicenter, retrospective study, we analyzed the weight loss, resolution of co-morbidities, and complications of both SG and RYGB using a case-control study design. METHODS: A retrospective, case-control, comparative analysis was performed with 200 patients in each treatment arm who had undergone either SG or RYGB from January 2005 to March 2008. The patients in each group were matched for age, gender, and body mass index. The postoperative complications, the percentage of excess weight loss, and the resolution of co-morbidities in each group were compared at 6, 12, and 18 months postoperatively. RESULTS: The overall mortality rates were similar in both groups. However, the morbidity rate was significantly greater in the RYGB group (20.5%) as compared to the SG group (6.5%; P <.05). The overall remission of type 2 diabetes was significantly better in the RYGB group (P <.05). However, the percentage of excess weight loss at 6, 12, and 18 months as well as the resolution of nondiabetes co-morbidities were comparable in both groups. CONCLUSION: In our study, as compared with SG, RYGB was associated with a greater short-term morbidity rate. RYGB could be associated with better diabetes control. However, additional studies are needed to evaluate the comparative efficacy of SG and RYGB for the treatment of morbid obesity and its co-morbidities.