Age- and sex-specific effects on weight loss outcomes in a comparison of sleeve gastrectomy and Roux-en-Y gastric bypass: a retrospective cohort study

Abstract

BackgroundRoux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) are the most common bariatric procedures undertaken globally but there are no evidenced-based criteria that inform the selection of one operation over the other. The purpose of this study was thus to compare weight loss outcomes between RYGBP and SG, and to define patient factors affecting weight loss.MethodsA single-centre two-year follow-up retrospective cohort study of all adults who underwent either RYGBP (n = 422) or SG (n = 432) between 2007 and 2012, at University College London Hospitals National Health Service Foundation Trust, an academic tertiary referral centre, was undertaken. Multilevel linear regression was used to compare weight loss between groups, enabling adjustment for preoperative BMI (body mass index) and evaluation for interaction factors.ResultsOne- and two-year results showed that unadjusted BMI loss was similar between groups; 13.7 kg/m2 (95% CI: 12.9, 14.6 kg/m2) and 12.8 kg/m2 (95% CI: 11.8, 13.9 kg/m2) for RYGBP patients respectively compared with 13.3 kg/m2 (95% CI: 12.0, 14.6 kg/m2) and 11.5 kg/m2 (95% CI: 10.1, 13.0 kg/m2) for SG patients respectively. Adjusting for preoperative BMI, there was 2.2 kg/m2 (95% CI: 1.5, 2.8) and 2.3 kg/m2 (95% CI: 1.3, 3.3) greater BMI loss in the RYGBP group compared to the SG group at one and two years respectively (P < 0.001 for both). The interaction analyses demonstrated that age and sex had important differential impacts on SG and RYGBP weight outcomes. Men under 40 and women over 50 years obtained on average far less benefit from SG compared to RYGBP, whereas men over 40 years and women under 50 years experienced similar weight loss with either procedure (P = 0.001 and 0.022 for interaction effects at one and two years respectively).ConclusionsOur results show that patient sex and age significantly impact on weight loss in a procedure-dependent manner and should be considered when choosing between RYGBP and SG. Optimizing procedure selection could enhance the effectiveness of bariatric surgery, thus further increasing the benefit-to-risk ratio of this highly effective intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/2052-9538-1-12) contains supplementary material, which is available to authorized users.

Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up

“…Both types of bariatric operations lead to significant weight loss, but the superiority of one type over another is disputable. Manning et al reported better weight loss after RYGB [17]. However, in our study, the difference between %EWL at each follow-up was not significant.…”

Impact of Depression on Weight Variation after Bariatric Surgery: A Three-Year Observational Study

“…We found that patients with DDBS lost on average 4.1 kg less of absolute weight than those without DDBS and the BMI variation was also 1.4 kg/m 2 less than those without DDBS. It is known, however, that there are some variables that may interfere with the outcomes of weight variation after BS [12][13][14]. After adjustment for sex, age, and BS type, this effect was maintained.…”

Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

“…There was little difference between the procedures for other factors. Most other studies have suggested that sleeve gastrectomy may be safer than gastric bypass [ 23 – 27 ], though some found no relevant differences [ 28 ]. These findings suggest that adverse outcomes after bariatric surgery are rare, hospital stays are short, and the benefits we report here outweigh the short-term risks involved.…”