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Standard and distal RYGB

No difference in PROMs between standard and distal RYGB

At baseline, 23% of patients reported a good to very good quality of life while two years after surgery, this increased to 51% of patients, with no difference between groups

There are no statistically significant differences between standard and distal Roux-en-Y gastric bypass (RYGB) two years post-surgery measured by patient-reported outcome measures (PROMs), according to the results from a double-blind randomised controlled trial byresearchers from Norway. The PROMS included weight loss, obesity-related quality of life, weight-related symptoms, anxiety, depression and eating behaviour. The paper, ‘Patient-Reported Outcome Measures 2 Years After Standard and Distal Gastric Bypass—a Double-Blind Randomized Controlled Trial’, was published in Obesity Surgery.

“We found improvements in most PROMs after both standard and distal RYGB, but no significant differences between groups after surgery in regard to obesity-specific HRQOL, weight-related symptoms, anxiety and depression, or eating behaviour,” the authors write. “There was comparable weight loss between the two groups, and we suspect the amount of weight lost could be a major determinant of improvement in HRQOL and other PROMs after bariatric surgery.”

The authors note that over the years there have been several modifications to the gold standard RYGB including altering the length of the common channel or the biliopancreatic limb and the ‘distal RYGB’ procedure has a relatively short common channel that could improve weight loss. Although previous studies have reported on BMI loss between the two procedures, there are no studies that have investigated the effect on health-related quality of life (HRQOL) and well-being, measured PROMs after distal and proximal RYGB.

The study included 113 patients, 57 patients received the RYGB standard procedure and 56 patients the distal RYGB, and 97% (n=110) of patients completed follow up at two-years. The standard RYGB had an alimentary limb of 150cm vs the distal RYGB had a common channel of 150cm

Outcomes

At two years, the total BMI loss was 17.8 after standard RYGB and 17.2 after RYGB distal, with no significant between-group differences (p=0.32). For HRQoL, the physical summary score improved in both groups and the mental summary score was unchanged, with no significant between-group difference. Obesity-related quality of life (OWLQOL) improved significantly in both groups, with no significant between-group differences.

Self-perceived quality of life improved significantly for all dimensions except for the work-related dimension after standard RYGB, and general self-esteem after distal RYGB. At baseline, 23% of patients reported a good to very good quality of life while two years after surgery, this increased to 51% of patients, with no difference between groups.

Both groups reported a significant reduction in the number of weight-related symptoms and symptom distress score with no significant difference between the groups. Most of the improvement in HRQOL and weight-related symptoms occurred during the first year, with only small changes between one and two years after surgery. Figure 1 shows estimated changes in obesity-specific HRQOL and weight-related symptoms over time.

Figure 1: Modelled changes in obesity-specific quality of life and weight-related symptoms after standard and distal RYGB

The mean eating behaviour scores did not differ significantly between groups after surgery: uncontrolled eating after standard RYGB (22.0) vs. distal RYGB (28.9), (p=0.06), cognitive restraint (57.4 vs. 62.1) points, p=0.16) and emotional eating (26.8 vs. 32.6) points, p=0.22).

The mean scores at two years for anxiety (HADS-A) were 5.2 points for standard and 5.1 points for distal RYGB, respectively (p=0.81), and the prevalence of clinically relevant anxiety was 22% after standard and 11% after distal RYGB (p=0.13). The mean depression scores were 2.8 points for standard and 2.1 points for distal (p=0.32), and the prevalence of clinically relevant depression was 9% after standard and 5% after distal (p=0.49).

“In patients with BMI50–60, both standard and distal RYGB lead to sustained weight loss and improved HRQOL 2 years after surgery,” the researchers concluded. “We found no significant differences between the two procedures in regard to obesity-specific HRQOL, weight-related symptoms, anxiety and depression, and eating behaviour. Standard RYGB continues to be our first choice in treating patients with BMI above 50.”

To access this paper, please click here

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