Laparoscopic sleeve gastrectomy versus laparoscopic single anastomosis gastric bypass: short-term outcome

Objective
To compare laparoscopic sleeve gastrectomy (LSG) and laparoscopic single anastomosis gastric bypass (LSAGB) for morbidly obese patients. Both procedures were compared regarding % of excess weight loss (%EWL), resolution of comorbidities, hospital stay, morbidity, mortality, and bariatric analysis and reporting outcome system (BAROS) on short-term basis.
Background
Bariatric surgery has been proved to be a successful treatment option, leading to long-term weight loss with improvement of obesity-related comorbidities. The LSG is now one of the most popular bariatric procedures worldwide, whereas the LSAGB is now rising worldwide.
Patients and methods
This prospective study involved 40 patients blindly divided into two groups: 20 of them underwent LSG and 20 of them underwent LSAGB. Written informed consent was obtained from all patients for the procedures and possible complications and conversion. The study was approved by the local ethical committee. All the patients had a 1-year period of follow-up postoperatively and were evaluated for % EWL, resolution of comorbidities, hospital stay, morbidity, mortality, and BAROS.
Results
A total of 40 obese patients were blindly divided into two groups: LSG included 20 patients, comprising three males and 17 females, with mean BMI of 43.7 kg/m. Among them, four had type 2 diabetes mellitus (T2DM), three had hypertension (HTN), five had osteoarthritis, two had obstructive sleep apnea (OSA), five had dyslipidemia, and one had polycystic ovary. LSAGB group included 20 patients, comprising four males and 16 females, having a mean BMI of 45.1 kg/m. Of them, 25 had T2DM, four had HTN, three osteoarthritis, one OSA, eight dyslipidemia, and two polycystic ovary. The mean operative time was 66 min in LSG, whereas it was 72.6 min in LSAGB. The mean duration of hospital stay was 2.5 days in LSG, whereas it was 3.5 days in LSAGB. Mean %EWL was 33.4% at 1 month and 77.22% at 12 months in LSG and was 20.13% at 1 month and 80.4% at 12 months in LSAGB. Overall, two patients with T2DM had complete and two had partial resolution in LSG, whereas three patients with T2DM in LSAGB. Moreover, two patients had complete resolution regarding HTN in LSG and all of them in LSAGB. There was resolution of osteoarthritis, OSA, and polycystic ovary in all patients in both groups. Bleeding was seen in one case in LSG. Wound infection was recorded in one case in LSG and in two cases in LSAGB. Postoperative nausea and vomiting was seen in three cases in LSG and in one cases in LSAGB. Symptomatic cholelithiasis was seen in seven patients in LSG group, and two patients needed surgery, whereas in LSAGB, five patients had symptomatic cholelithiasis, and three patients needed surgery. A total of eight patients had dumping symptoms only in LSAGB. According to BAROS, it was revealed that in LSG, 12 of the patients evaluated the quality of life as ‘excellent’ and two as ‘very good,’ whereas in LSAGB, 14 of the patients evaluated the quality of life as ‘excellent’ and three as ‘very good.’
Conclusion
LSG has proved to be a safe and effective bariatric surgery with a rate of success that is similar to the LSAGB. LSAGB appears to reduce obesity-related comorbidities with low complication rate. Both procedures offer a good quality of life according to BAROS.