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Omega-Loop vs RYGB

Omega-Loop results in deterioration of liver parameters

The results show that compared to RYGB, OLGB showed a greater weight loss percentage (94±36 vs.127±31%, p<0.001), whilst liver transaminases was report to have dropped in RYGB patient, but rise in OLGB patients.

Omega-loop gastric bypass (OLGB) results in greater weight loss and deterioration of liver parameters in the first year after surgery with no association to weight loss, compared to Roux-en-Y gastric bypass (RYGB), according to the researchers from the Medical University of Vienna, Vienna, Austria. The study authors state that although it is known the procedure results in weight loss, its impact on the differences in liver, cholestatic and metabolic parameters, compared to RYGB, has not previously been examined.

The study, ‘The Effect of Roux-en-Y vs. Omega-Loop Gastric Bypass on Liver, Metabolic Parameters, and Weight Loss’, published in Obesity Surgery, was undertaken to compare the development of hepatic and metabolic markers as well as weight loss between the two surgical procedures during the first postoperative year.

For the study, the researchers matched 50 patients by age, gender and BMI who underwent either OLGB (n=25, male = 88%, 43.8±13.1a, 128±24kg, BMI45.3±5.3) or RYGB (n=25, female = 92%, 44.6±10.3a, 125±18kg, BMI45.6±4.1).

Outcomes

The results show that compared to RYGB, OLGB showed a greater weight loss percentage (94±36 vs.127±31%, p<0.001), whilst liver transaminases was report to have dropped in RYGB patient, but rise in OLGB patients. However, the authors found no correlation between aspartate transaminase, alanine transaminase and weight loss.

They note that gamma-glutamyltransferase decreased significantly in RYGB patients over the first three months, while it increased in OLGB patients. They also found higher levels of triglycerides, insulin, homeostasis model assessment of insulin resistance (HOMA2-IR), and liver fat percentage in RYGB at baseline, despite matching the groups for age, sex and BMI. Those differences disappeared, except for triglycerides, within one year. All metabolic parameters correlated with weight loss.

“The superiority of omega-loop gastric bypass over Roux-en-Y gastric bypass in terms of WL was demonstrated in previous studies, as well as in our study,” the authors write. “We did not observe any influence of gender, age, or preoperative BMI on weight loss regardless of the procedure…In our study, the increase of liver transaminases (ALT, AST) was greater in omega-loop gastric bypass than in Roux-en-Y gastric bypass with a maximum rise after three months.”

The authors do acknowledge that their study is limited by the small sample size, due to the restricted availability of non-diabetic omega-loop gastric bypass data, and well as the absence of liver biopsies pre-operatively and during the postoperative period, which possibly could explain the results in omega-loop gastric bypass.

“Given the potential for worsening fibrosis following bariatric surgery, patients should be monitored closely and continue to undergo through hepatological workup, including non-invasive testing for fibrosis or, even liver biopsy,” the researchers conclude. “More research in this field, including histopathological data, is needed to define clinical relevance of these findings on hepatic outcome in terms of deterioration of non-alcoholic steatohepatitis and fibrosis and to characterise patients at risk.”

The article was edited from the original article, under the Creative Commons license. To access the article, please click here

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