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

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

The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery. We prospectively investigated the effects of the bilio-intestinal bypass (BI-bypass) with a wide cholecysto-jejunal anastomosis and of adjustabl...

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Bibliographic Details
Published in:Obesity surgery Vol. 15; no. 3; pp. 367 - 377
Main Authors: Corradini, Stefano Ginanni, Eramo, Annarita, Lubrano, Carla, Spera, Giovanni, Cornoldi, Alessandra, Grossi, Antonio, Liguori, Francesca, Siciliano, Maria, Pisanelli, Massimo Codacci, Salen, Gerald, Batta, Ashok Kumir, Attili, Adolfo Francesco, Badiali, Marco
Format: Journal Article
Language:English
Published: United States Springer Nature B.V 01-03-2005
Subjects:
Adult
Bile Acids and Salts - analysis
Biliopancreatic Diversion - methods
Cholestanol - analysis
Cholesterol
Cholesterol - analysis
Cholesterol - blood
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Diet
Feces - chemistry
Female
Follow-Up Studies
Gastric Bypass - methods
Gastrointestinal surgery
Humans
Hypercholesterolemia - blood
Hypercholesterolemia - therapy
Jejunoileal Bypass - methods
Low density lipoprotein
Male
Obesity, Morbid - blood
Obesity, Morbid - surgery
Phytosterols - analysis
Prospective Studies
Triglycerides - blood
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Summary:The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery. 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). 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. 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.
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ISSN:0960-8923
1708-0428
DOI:10.1381/0960892053576839