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The best long-term weight loss surgery is not yet clear



(Reuters Health) – People with obesity may initially shed more pounds with an older operation known as Roux-en-Y gastrotomy, than with a newer sleeve gastricectomy, but a review of the study suggests it is longer is better for weight loss remains unknown.

The researchers looked at data from previous studies of a total of 2,475 obese patients in 13 countries who underwent weight loss surgery between 2006 and 2018. One year after the operation, Roux-en-Y resulted in a greater attenuation of gastrectomy on the sleeves, and this trend persisted three years after the procedure.

But five years after the surgery, there was insufficient evidence to determine whether one procedure could be better than the other, researchers at Annals of Surgery conclude.

"There is insufficient data from the RCTs to draw conclusions about long-term comparative effectiveness," lead study author Jung Lee from McMaster University in Hamilton, Ontario, and colleagues wrote.

Surgical weight loss has gained traction in recent years as an increasing number of extremely obese patients are turning to this option after failing to lose weight through diet, exercise or medication. Like any operation, it is not risky, and bariatric operations in particular have a risk of malnutrition.

With gastrectomy on the sleeve, surgeons divide and remove about 80 percent of the abdomen using special surgical staples, which leave the abdomen looking like a long thin banana.

For Roux-en-Y gastric bypass surgery, the same surgical staples are used to divide the stomach to create a small egg size case. Surgeons then make a connection between the pouch and the small intestine, so that the food travels directly to the end of the small intestine, bypassing the stomach and the first part of the small intestine.

Researchers have focused on changes in the body mass index (BMI), a measure of weight in relation to height. BMI between 18.5 and 24.9 is considered healthy, while 25 to 29.9 are overweight, 30 or more are obese, and 40 or more is what is known as serious or morbid obesity.

All patients in the analyzes were considered good candidates for weight loss surgery according to current treatment guidelines because they were seriously obese people with BMI over 40 or obese with BMI over 35 having chronic health problems related to obesity.

One year after surgery, patients who had Roux-en-Y procedures had an average BMI reduction of 1.25 points more than with sleeve gastrectomy, the study said.

More patients with Roux-en-Y had a high cholesterol return to normal within one year of surgery than with sleeve gastrectomy, the study said.

There was no significant difference between the percentages of patients who remitted to conditions such as diabetes and high blood pressure.

The rates of minor and more serious complications are similar.

One limitation of the analysis is that few of the smaller included studies reported for five-year outcomes, the researchers note.

Another disadvantage is that BMI is no longer considered an ideal way to evaluate the effectiveness of weight loss interventions, the study team points out.

SOURCE: bit.ly/2XemgcJ Annals of Surgery, online October 23, 2019.

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