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With obesity levels on the rise around the world, so too are procedures aiming to cure this condition. A recent short news article published in the British Medical Journal looked at the benefits of one such procedure – the sleeve gastrectomy.
Healthcare professionals are using many different tactics to try to tackle obesity. These can include non-surgical methods, such as dietary and lifestyle interventions, or bariatric surgery, which involves surgically reducing the size of the stomach. Although stomach-reduction surgery is a drastic measure, it is currently the only method that has been proven to help very obese patients to lose weight, maintain their weight loss, and to improve their overall health.
The gold standard of bariatric surgery is currently the Roux-en-Y bypass, which as the name suggests, involves surgery to bypass a large portion of the stomach. However, during the last ten years another technique, the sleeve gastrectomy, has gained popularity. The sleeve gastrectomy involves removing part of the stomach and is therefore technically easier to perform than the Roux-en-Y bypass. Short-term evidence also implies that this technique could produce similar weight loss results to that of bypass surgery with a lower risk of perioperative complications. Despite these seeming advantages, the long-term effects had not been investigated until now.A recent short research news article, published in British Medical Journal, presented the outcomes of three long-term studies published in 2017.
An Israeli study demonstrated the benefits of surgical interventions over non-surgical treatment options. This study retrospectively compared 8,385 obese patients who had surgical interventions (sleeve gastrectomy, bypass, adjustable gastric band) with 21,155 obese patients who had non-surgical obesity treatments (dietary counselling and behaviour modification). Approximately four years after receiving intervention, patients who had surgery had a lower rate of death from any cause (1.3%) regardless of the type of surgery compared to those who had non-surgical interventions (2.3%). Surgery was also associated with better weight loss and a decrease in other co-existing health conditions, such as diabetes, high blood pressure, and dyslipidemia.
Unlike the Israeli study, two randomized controlled trials in Switzerland (217 patients) and Finland (240 patients) directly compared the Roux-en-Y bypass and sleeve gastrectomy methods. The Swiss study found both methods were equivalent in terms of body mass index decreases, weight loss, improved quality of life, and complications three years post-surgery. However, they found that the Roux-en-Y bypass was a better treatment option for patients with hiatal hernia, cardiovascular risk factors, dyslipidemia, and pre-existing gastroesophageal disease (GERD). In fact, the latter two conditions did not improve in a number of patients following sleeve gastrectomy. Similarly, the Finnish study also found that weight loss, improved quality of life, and long-term complications five years post-surgery were similar between the two techniques. Moreover, as with the Swiss study, sleeve gastrectomy was associated with GERD problems, with a substantial number of Finnish patients developing GERD following this method.
Overall, these long-term studies indicate that sleeve gastrectomy is just as effective and safe as the current gold standard surgical treatment for obesity, although there are issues with GERD following sleeve gastrectomy. Encouragingly, experts find the data reassuring and believe that both techniques are viable options to consider when bariatric surgery is required.
Written by Natasha Tetlow, PhD
References: Wise, J. Sleeve gastrectomy matches gastric bypass in terms of weight loss and health benefits. BMJ.2018. Available at: doi: 10.1136/bmj.k215. Plus all references cited within this article.