Inflammation, insulin resistance, lipid disturbances, anthropometrics, and metabolic syndrome in morbidly obese patients: a case control study comparing laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy

Antonio Iannelli, Rodolphe Anty, Anne Sophie Schneck, Albert Tran, Jean Gugenheim
Surgery 2011, 149 (3): 364-70

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure that has several advantages over Roux-en-Y gastric bypass, but data on the effectiveness of this procedure on metabolic syndrome have rarely been reported.

METHODS: This case control study compared the incidence of low grade systemic inflammation, insulin resistance, anthropometrics, lipid disturbances, and metabolic syndrome in 12 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) and 10 patients undergoing LSG, matched for age, sex, body mass index (BMI), and HbA1c.

RESULTS: At 6 months after surgery, there was no significant difference in any of the parameters investigated. Metabolic syndrome improved in all five patients undergoing LRYGBP and in 4 out of 6 patients undergoing LSG (ns). At 1 year after surgery, patients in the LRYGBP group had a significantly lower BMI (32.6 ± 5.1 vs 36.5 ± 2.5 kg/m(2); P < .05) and percent of excess BMI lost (70.1 ± 20.5 vs 55.3 ± 12.8; P < .05), and had significantly lower plasma levels of C-reactive protein (2.3 ± 1.5 vs 5.1 ± 4.6 mg/L; P < .05), total cholesterol (4.7 ± 1 vs 5.6 ± 0.3 mmol/L; P < .001) and LDL cholesterol (2.7 ± 0.7 vs 3.7 ± 0.3 mmol/L; P < .001). Remission of metabolic syndrome was significantly less common after LSG at 1 year than LRYGBP (3 vs 0 patients; P < .05).

CONCLUSION: In this limited study patients undergoing LRYGBP demonstrated significantly lower BMIs, improved lipid profiles, decreased systemic low-grade inflammation and less metabolic syndrome than those with LSG at 1-year follow-up.

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