Do patients with higher baseline BMI have improved weight loss with Roux-en-Y gastric bypass versus sleeve gastrectomy?

Background: As sleeve gastrectomy (SG) becomes the most common bariatric procedure, it remains unclear for which patients laparoscopic Roux-en-Y gastric bypass (LRYGB) may be advantageous. Some contend that patients with higher initial body mass index (BMI) achieve better weight loss with LRYGB. Objectives: This study evaluates weight loss in SG versus LRYGB patients based on preoperative BMI. Setting: Community teaching hospital, Baltimore, Maryland. Methods: A convenience cohort of 4935 individuals, undergoing bariatric surgery from 2001 to 2015, was studied to examine 5-year postsurgical trends in weight loss stratified by baseline BMI and procedure. Student t tests compared mean weight loss of baseline BMI groups (<45 versus >= 45; <50 versus >= 50; and <55 versus >= 55) and line graphs and plotted 95% confidence intervals of mean weight loss by year were examined to discern differences in percent excess weight loss (%EWL) by procedure type. Results: All patients were more likely to be female (79%) and Caucasian (62.5%). Nearly twice as many patients underwent LRYGB (N=3236) compared with SG (N=1699). In patients in the BMI <45, 50, and 55 kg/m(2) categories, there was no significant difference in %EWL based on procedure. However, in those patients in the BMI >= 45 and 55 kg/m(2) categories, there is significantly higher %EWL in the LRYGB group over SG. Conclusion: In conclusion, patients with lower baseline BMI had improved %EWL regardless of procedure, but those patients with higher baseline BMI who underwent LRYGB did have higher %EWL than those undergoing SG at 2 years follow-up. BMI is one of many key factors when selecting a procedure for an individual patient. (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.