Endocrine Abstracts

Introduction: Bariatric surgery (BS) has emerged as the most effective treatment for severe obesity, but weight regain after surgery is an important issue. The aim of this study was to evaluate the impact of different surgical techniques on long-term dynamic weight loss pattern.

Materials and methods: We retrospectively included 444 patients with BMI > 35 kg/m² who underwent different BS techniques: Sleeve gastrectomy (SG; n: 80), Roux-en-Y gastric bypass (RYGBP; n: 242) or biliopancreatic diversion (BPD; n: 122). Patients were followed-up for 5 years. We evaluated percentage of the total weight loss (%TWL), excess weight loss (%EWL, considering ideal weight as BMI= 25 kg/m²) and weight regain (WR) > 15% from nadir. Patients were classified in 3 pattern groups: a) Successful: maintained EWL >50% for 5-years; b) Late failure: reached %EWL>50% but presented %EWL<50% at the end of follow-up and c) Early failure: persistent %EWL<50% throughout the follow-up. Statistic analysis: descriptive data expressed as mean (SD), median or percentage. T-Test for unpaired data and χ² test for qualitative data was performed.

Results: Patients with SG were younger [40.3 (13.8)] than RYGBP [45.1 (10.6)] or BPD [46.9 (12.2)] (P<0.01) and less obese [BMI 43.6 (8.7)] vs 44.7 (6.3) and 46.9 (12.2), respectively (P<0.05). The EWL at weight nadir (1–2 years) was excellent for all BS (median 88% for SG and RYGBP and 98% for BPD). EWL% declined at 5 year-follow-up but, was similar between SG and RYGBP (median 66 vs 71%) and lower than BPD (85%; P< 0.01). When loss weight is expressed as TWL >30% at 5-year follow-up, a clear inferiority is observed in patients undergoing SG (30%) vs RYGBP (51%) vs BPD (78%); P<0.001. Although WR>15% was similar in all types of BS (SG 37.5%, RYGBP 33.9%, BPD 34%), the impact on final follow-up weight loss pattern was outstanding for BPD (P< 0.001) (see table below)

Conclusions: In this cohort, all BS lead to major weight loss in the short term. BPD presented higher percentage of success than the other techniques. No differences were found in baseline characteristics between successful, late and early failure weight loss patterns. More studies are needed to determine useful predictors of success and WR after BS.