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Short-Term Outcomes of Sleeve Gastrectomy plus Jejunojejunal Bypass: a Retrospective Comparative Study with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Chinese Patients with BMI ≥ 35 kg/m2

  • Shibo Lin
  • Wei Guan
  • Ningli Yang
  • Yan Zang
  • Ruiping Liu
  • Hui LiangEmail author
Original Contributions
  • 62 Downloads

Abstract

Background

Bariatric surgery represents the most effective treatment for obesity and its related comorbidities. The present study aims to evaluate the efficacy and safety of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB).

Methods

This retrospective study included 244 obese patients with BMI ≥ 35 kg/m2 undergoing SG + JJB (n = 83), SG (n = 82), and Roux-en-Y gastric bypass (RYGB) (n = 79). Postoperative weight loss, metabolic outcomes, nutrition status, and patients’ complaints at 1-year follow-up were compared. Subgroup analyses (36 pairs of SG + JJB/SG and 37 pairs of SG + JJB/RYGB) were performed to compare weight loss and lipid profiles after matching with gender, age, and BMI.

Results

In subgroup case-matched study, SG + JJB exhibited superior weight loss effect to SG regarding total weight loss (38.8 ± 8.7% vs 35.0 ± 6.1%, P = 0.011) and excessive weight loss (95.3 ± 20.4% vs 86.9 ± 13.7%, P = 0.033) at 1-year follow-up. The postoperative metabolic outcomes, nutritional status, and patients’ complaints were similar between SG + JJB and SG. SG + JJB yielded similar weight loss, T2DM remission, and hypertension resolution to RYGB at 1-year follow-up, but less postoperative complications than RYGB regarding anemia (4.8% vs 22.8%), vitamin D deficiency (47.0% vs 65.8%), vitamin B12 deficiency (8.4% vs 25.3%), hypoalbuminemia (1.2% vs 8.9%), diarrhea (6.0% vs 21.5%), dumping syndrome (0 vs 7.6%), and fatigue (25.3% vs 40.5%) (P < 0.05). In subgroup case-matched study, RYGB improved total cholesterol and low-density lipoprotein better than SG + JJB (P < 0.05).

Conclusions

In short-term follow-up, SG + JJB offered better weight loss than SG and similar weight loss to RYGB. SG + JJB resulted in less postoperative nutritional deficiency and complications than RYGB except for lipid and hypertension improvement.

Keywords

Obesity Sleeve gastrectomy Jejunojejunal bypass Weight loss Complication Roux-en-Y gastric bypass 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University (2018-SR-054).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.  https://doi.org/10.1136/bmj.f5934.CrossRefGoogle Scholar
  2. 2.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.  https://doi.org/10.1056/NEJMoa066254.CrossRefGoogle Scholar
  3. 3.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.  https://doi.org/10.1007/s11695-017-2666-x.CrossRefGoogle Scholar
  4. 4.
    Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11):4331–45.  https://doi.org/10.1007/s00464-017-5505-1.CrossRefGoogle Scholar
  5. 5.
    Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine. 2017;96(46):e8632.  https://doi.org/10.1097/MD.0000000000008632.CrossRefGoogle Scholar
  6. 6.
    Dogan K, Homan J, Aarts EO, et al. Long-term nutritional status in patients following roux-en-Y gastric bypass surgery. Clin Nutr. 2018;37(2):612–7.  https://doi.org/10.1016/j.clnu.2017.01.022.CrossRefGoogle Scholar
  7. 7.
    Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surg Obes Relat Dis. 2016;12(1):11–20.  https://doi.org/10.1016/j.soard.2015.04.011.CrossRefGoogle Scholar
  8. 8.
    Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.  https://doi.org/10.1097/SLA.0b013e3182263b66.CrossRefGoogle Scholar
  9. 9.
    Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18(10):1287–96.  https://doi.org/10.1007/s11695-008-9456-4.CrossRefGoogle Scholar
  10. 10.
    Hans PK, Guan W, Lin S, et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg. 2017;41:285–90.  https://doi.org/10.1016/j.asjsur.2017.04.003.CrossRefGoogle Scholar
  11. 11.
    Meany G, Conceicao E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. Eur Eat Disord Rev. 2014;22(2):87–91.  https://doi.org/10.1002/erv.2273.CrossRefGoogle Scholar
  12. 12.
    Lee WJ, Lee KT, Kasama K, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass. Obes Surg. 2014;24(1):109–13.  https://doi.org/10.1007/s11695-013-1067-z.CrossRefGoogle Scholar
  13. 13.
    Lee WJ, Almulaifi AM, Tsou JJ, et al. Duodenal-jejunal bypass with sleeve gastrectomy versus the sleeve gastrectomy procedure alone: the role of duodenal exclusion. Surg Obes Relat Dis. 2015;11(4):765–70.  https://doi.org/10.1016/j.soard.2014.12.017.CrossRefGoogle Scholar
  14. 14.
    Alamo M, Sepulveda M, Gellona J, et al. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patients with body mass index <35 kg/m2. A cohort study. Obes Surg. 2012;22(7):1097–103.  https://doi.org/10.1007/s11695-012-0652-x.CrossRefGoogle Scholar
  15. 15.
    Sepulveda M, Alamo M, Preiss Y, et al. Metabolic surgery comparing sleeve gastrectomy with Jejunal bypass and Roux-en-Y gastric bypass in type 2 diabetic patients after 3 years. Obes Surg. 2018;28(11):3466–73.  https://doi.org/10.1007/s11695-018-3402-x.CrossRefGoogle Scholar
  16. 16.
    Lin S, Guan W, Hans P, et al. Status of laparoscopic sleeve gastrectomy in China: a national survey. Obes Surg. 2017;27(11):2968–73.  https://doi.org/10.1007/s11695-017-2727-1.CrossRefGoogle Scholar
  17. 17.
    Berger AM, Mooney K, Alvarez-Perez A, et al. Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw. 2015;13(8):1012–39.CrossRefGoogle Scholar
  18. 18.
    Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77.  https://doi.org/10.2337/dc16-0236.CrossRefGoogle Scholar
  19. 19.
    Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes. 2011;35(Suppl 3):S45–9.  https://doi.org/10.1038/ijo.2011.148.CrossRefGoogle Scholar
  20. 20.
    Halverson JD, Scheff RJ, Gentry K, et al. Long-term follow-up of jejunoileal bypass patients. Am J Clin Nutr. 1980;33(2 Suppl):472–5.  https://doi.org/10.1093/ajcn/33.2.472.CrossRefGoogle Scholar
  21. 21.
    Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239(1):1–11.  https://doi.org/10.1097/01.sla.0000102989.54824.fc.CrossRefGoogle Scholar
  22. 22.
    Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.  https://doi.org/10.1038/nrendo.2012.48.CrossRefGoogle Scholar
  23. 23.
    Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004;89(6):2595–600.  https://doi.org/10.1210/jc.2004-0372.CrossRefGoogle Scholar
  24. 24.
    Praveen Raj P, Bhattacharya S, Saravana Kumar S, et al. Comparison of effects of sleeve gastrectomy and gastric bypass on lipid profile parameters in Indian obese: a case matched analysis. Obes Surg. 2017;27(10):2606–12.  https://doi.org/10.1007/s11695-017-2692-8.CrossRefGoogle Scholar
  25. 25.
    Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54.  https://doi.org/10.1001/jama.2017.20313.CrossRefGoogle Scholar
  26. 26.
    Melissas J, Stavroulakis K, Tzikoulis V, et al. Sleeve gastrectomy vs Roux-en-Y gastric bypass. Data from IFSO-European chapter Center of Excellence Program. Obes Surg. 2017;27(4):847–55.  https://doi.org/10.1007/s11695-016-2395-6.CrossRefGoogle Scholar
  27. 27.
    Powell-Jackson PR, Maudgal DP, Sharp D, et al. Intestinal bacterial metabolism of protein and bile acids: role in pathogenesis of hepatic disease after jejuno-ileal bypass surgery. Br J Surg. 1979;66(11):772–5.CrossRefGoogle Scholar
  28. 28.
    Ogata Y, Nishi M, Nakayama H, et al. Role of bile in intestinal barrier function and its inhibitory effect on bacterial translocation in obstructive jaundice in rats. J Surg Res. 2003;115(1):18–23.CrossRefGoogle Scholar
  29. 29.
    Ishida RK, Faintuch J, Ribeiro AS, et al. Asymptomatic gastric bacterial overgrowth after bariatric surgery: are long-term metabolic consequences possible? Obes Surg. 2014;24(11):1856–61.  https://doi.org/10.1007/s11695-014-1277-z.CrossRefGoogle Scholar
  30. 30.
    Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605.  https://doi.org/10.1007/s11695-016-2343-5.CrossRefGoogle Scholar
  31. 31.
    Wolvekamp MC, Heineman E, Taylor RG, et al. Towards understanding the process of intestinal adaptation. Dig Dis. 1996;14(1):59–72.  https://doi.org/10.1159/000171539.CrossRefGoogle Scholar
  32. 32.
    Hassn A, Luhmann A, Rahmani S, et al. Medium-term results of combined laparoscopic sleeve gastrectomy and modified Jejuno-Ileal bypass in bariatric surgery. Obes Surg. 2016;26(10):2316–23.  https://doi.org/10.1007/s11695-016-2098-z.CrossRefGoogle Scholar
  33. 33.
    Vidal P, Ramon JM, Goday A, et al. Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg. 2014;24(2):179–83.  https://doi.org/10.1007/s11695-013-1094-9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General surgeryThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina

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