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  • Title: Short-Term Outcomes of Inflammatory Bowel Disease after Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.
    Author: Heshmati K, Lo T, Tavakkoli A, Sheu E.
    Journal: J Am Coll Surg; 2019 Jun; 228(6):893-901.e1. PubMed ID: 30797083.
    Abstract:
    BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies for obesity and may have beneficial effects on the immune system. Therefore, we compared RYGB vs SG outcomes in patients with inflammatory bowel disease (IBD). STUDY DESIGN: In this retrospective cohort study, we identified 54 patients with either Crohn's disease (CD; n = 31) or ulcerative colitis (UC; n = 23), diagnosed before bariatric surgery, between 2000 and 2017. Nineteen patients underwent RYGB and 35 patients underwent SG. RESULTS: Patients presenting for RYGB and SG were of similar age (46.2 ± 9.5 years vs 47.2 ± 12.3 years), preoperative BMI (48.5 ± 7.7 kg/m2 vs 44.9 ± 7.3 kg/m2) and IBD status, as measured by medications. Both operations led to significant weight loss at 1 year. After RYGB and SG, there were no significant differences in the proportion of patients with UC who had improved (27% vs 8%), unchanged (64% vs 92%), or worse (9% vs 0%) IBD medication requirements, respectively. Similar analysis in the patients with CD showed no significant differences in the proportion who had improved (37.5% vs 44%), or unchanged (25% vs 52%) IBD-medication requirements after RYGB and SG, respectively. However, there was a significant difference in the proportion of patients who had worsened CD after RYGB compared with SG (37.5% vs 4%; p = 0.016). There was a greater rate of surgical complications after RYGB compared to SG (26% vs. 3%; p = 0.02). CONCLUSIONS: A sizable proportion of patients experienced improvements in IBD post-bariatric surgery. However, in CD patients, RYGB was associated with a significantly greater number of patients with increased IBD-medication requirements. Sleeve gastrectomy led to less weight loss, but had a lower rate of severe complications compared with RYGB. In patients with IBD, and particularly CD, SG may be the safer surgery.
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