Comparison of changes in lipid profile after bilio-intestinal bypass and gastric banding in patients with morbid obesity.

Abstract

BACKGROUND:

The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery.

METHODS:

We prospectively investigated the effects of the bilio-intestinal bypass (BI-bypass) with a wide cholecysto-jejunal anastomosis and of adjustable gastric banding (AGB) on blood lipid concentrations in obese patients. To clarify the mechanism of the hypocholesterolemic effect of the BI-bypass, daily fecal sterol excretion was measured by gas-liquid chromatography (GLC).

RESULTS:

At 1 year after BI-bypass compared to baseline, the hypercholesterolemic (n=18) and the normocholesterolemic (n=19) patients significantly reduced total (-38% and -27%, respectively), LDL (-47% and -24%, respectively) and HDL (-11% and -13%, respectively) cholesterol and total / HDL cholesterol ratio (-25% and -13%, respectively). At 1 year after AGB, the total / HDL cholesterol ratio was significantly decreased (-11%) compared to baseline in hypercholesterolemic (n=12) but not in normocholesterolemic (n=6) patients, while total and LDL cholesterol were not affected in both groups. At 3 years after BI-bypass compared to baseline, the hypercholesterolemic (n=9) and the normocholesterolemic (n=11) patients significantly reduced total (-43% and -28%, respectively) and LDL (-53% and -29%, respectively) cholesterol and total / HDL cholesterol ratio (-38% and -21%, respectively). The BI-bypass induced a significant (P <0.005; n=7) 6-fold increase in mean fecal cholesterol output.

CONCLUSIONS:

The BI-bypass but not the AGB leads to a persistent and marked beneficial effect on blood LDL cholesterol associated with an increased cholesterol fecal output. BI-bypass but not AGB is indicated in morbidly obese patients with hypercholesterolemia.

• Authors: Stefano Ginanni Corradini, Annarita Eramo, Carla Lubrano, Giovanni Spera, Alessandra Cornoldi, Antonio Grossi, Francesca Liguori, Maria Siciliano, Massimo Codacci Pisanelli, Gerald Salen, Ashok Kumir Batta, Adolfo Francesco Attili, Marco Badiali
• Journal: Obesity surgery (Obes Surg) Vol. 15 Issue 3 Pg. 367-77 (Mar 2005) ISSN: 0960-8923 [Print] United States
• PMID: 15826472 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Bile Acids and Salts
• Cholesterol, HDL
• Cholesterol, LDL
• Phytosterols
• Triglycerides
• Cholestanol
• Cholesterol

Topics

• Adult
• Bile Acids and Salts (analysis)
• Biliopancreatic Diversion (methods)
• Cholestanol (analysis)
• Cholesterol (analysis, blood)
• Cholesterol, HDL (blood)
• Cholesterol, LDL (blood)
• Feces (chemistry)
• Female
• Follow-Up Studies
• Gastric Bypass (methods)
• Humans
• Hypercholesterolemia (blood, therapy)
• Jejunoileal Bypass (methods)
• Male
• Obesity, Morbid (blood, surgery)
• Phytosterols (analysis)
• Prospective Studies
• Triglycerides (blood)