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Impact of Laparoscopic Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy on Postoperative Lipid Values
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
ultrasonography presented steatosis in 97 (54.4%) cases of mild steatosis, in 161 (67.6%) moderate steatosis and in 268 (80.4%) of severe steatosis, qui-square ¼ 38.573, P o0.001. Conclusion: It was observed an increase on ultrasonography sensibility as the degree of steatosis increase in this group of patients.
S97
ABC Study cohort LAGB
CPAP
P value
Pre-surgery Age
51.3 ± 8.9
48.4 ± 9.4
NS
Male %
47%
68%
NS
BMI
39.1 ± 2.8
38.9 ± 3.1
NS
Initial AHI
49.7 ± 24.8
48.9 ± 26.7
NS
8.9 ± 2.6
11.4 ± 5.1
NS
Reduction in BMI at 9-months
5.2 ± 2.6
0.7 ± 2.6
P<0.05
Improvement at AHI at 9-months
- 20.4 ± 26.0
- 6.6 ± 25.3
P<0.05
Improvement in effective AHI at 9-months
- 20.4 ± 26.0
- 26.9 ± 31.2
NS
Improvement in ESS score
- 2.2 ± 5.3
- 3.4 ± 4.6
NS
Initial ESS score Post-surgery
A5079
CORRELATION BETWEEN DYSLIPIDEMIA IMPROVEMENT AND CHANGES AT BODY FAT PERCENTAGE IN MORBIDLY OBESE PATIENTS SUBJECTED TO GASTRIC BYPASS Alexandre Padoin, MD PhD1; Felipe Laranjeira2; Luiza Lubianca, MD2; Rafael Ramos, MD3; Letícia Alves, MD MsC1; Cláudio Mottin, MD PhD1; 1Faculdade de Medicina e Serviço de Cirurgia Bariátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; 2Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; 3Serviço de Cirurgia Bariátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil Background: Body Mass Index although it`s practicality have limitations. The aim of this study is evaluate the correlation between dyslipidemia improvement and body fat percentage changes. Methods: We conducted an observational, retrospective cohort study of patients subjected to gastric bypass. We selected patients who underwent bioimpedance analysis and laboratory tests before surgery at 3, 6 and 12 months postoperatively. Results: We studied 228 patients with a mean age of 37.4 ⫾ 11.7 years old. Most patients were female (76.3%). Initially, 143 patients (66.2%) showed criteria for dyslipidemia, and 6 months after surgery, this number fell to 83 patients (50.6%) and continued falling over time to only 45 patients (28.5%) 12 months after surgery. In relating different variables with the decrease in percent body fat at 12 months, a significant association was seen with weight loss (r¼0.258; p¼0.009), BMI (r¼0.272; p¼0.005) and waist circumference (r¼0.357, p o0.001). However, the only biochemical parameter showing a significant association was HDL-C level (r¼-0.267; p¼0.009). Patients with the greatest decrease in body fat percentage were those with the largest decrease in weight, BMI and waist circumference and highest increase in HDL-C level. Conclusion: This study demonstrated the association of decrease in percent body fat with increase in HDL-C, regardless of sex and age. The same association was also observed when using the parameters BMI, weight loss and waist circumference. A5080
ABC STUDY: RESULTS OF THE FIRST US RANDOMIZED TRIAL OF BARIATRIC SURGERY FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA Ali Tavakkoli, MD; Wei Wang, PhD; Robert Andrews; Sanjay Patel, MD; Dept of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
Background: Obesity is the most common risk factor for obstructive sleep apnea (OSA) and current treatment with continuous positive airway pressure (CPAP) is often poorly tolerated. Bariatric surgery has been shown to improve OSA severity but these studies have primarily occurred in patients seeking weight loss surgery who are incidentally found to have OSA. We initiated an NIH-sponsored randomized trial of CPAP versus bariatric surgery as initial therapy in patients presenting to a sleep disorders clinic with symptomatic severe OSA (NCT01187771). Methods: Adult patients with severe OSA and body mass index (BMI) of 35-45 kg/m2 were recruited from two academically affiliated groups of sleep centers and randomized to either CPAP therapy or laparoscopic gastric banding surgery (LAGB). Followup evaluations to assess weight, OSA severity and OSA symptoms were performed at 9 months and 18 months following randomization by blinded observers. Results: Out of 481 patients meeting eligibility criteria, 97 (20%) attended an informational meeting and 53 enrolled in the study with 49 being randomized (Table 1). There were no major surgical complications. Incidences of adverse events between the 2 treatment groups were similar. LAGB patients had a greater degree of weight loss and reduction in apnea hypopnea index (AHI), although the improvement in effective AHI (AHI accounting for CPAP use) and Epworth Sleepiness Scale (ESS) were similar. Satisfaction with treatment assignment was similar between the 2 groups. The differences in outcomes were persistent at the 18month evaluation time point. Conclusion: LAGB is a viable alternative to CPAP at reducing AHI and improving OSA symptoms. Patient satisfaction and incidence of adverse events is similar between LAGB and CPAP. Further studies randomizing patients to more invasive surgeries with greater weight loss are needed and can be justified. A5081
IMPACT OF LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY ON POSTOPERATIVE LIPID VALUES Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Bariatric surgery has been shown to significantly improve many obesity-related comorbidities, including dyslipidemia. Previous research in the early postoperative period has demonstrated inconsistent results in lipid values after laparoscopic
S98
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211 Postoperative lipid values for LRYGB vs. LSG.
Lipid value, mg/dL
LRYGB
LSG
Nutrient deficiencies in patients after LRYGB vs. LSG P value
N
Mean ± SD
N
Mean ± SD
Total cholesterol
872
161.2 ± 30.6
71
184.2 ± 38.9
<0.001
LDL
860
84.3 ± 25.1
70
105.3 ± 33.8
<0.001
HDL
868
59.0 ± 14.0
71
60.3 ± 13.1
0.999
Triglycerides
866
90.1 ± 39.6
71
97.0 ± 40.3
0.600
Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and LDL in LRYGB vs. LSG, and others reporting no significant differences. Our objective was to evaluate the postoperative lipid values in LRYGB vs. LSG. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6-18 months postoperative were evaluated. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 872 and 71 patients who underwent LRYGB and LSG during the study period, respectively, for whom measurements of lipid values from 6-18 month postoperative period were available. The mean preoperative BMI was 47.3 kg/ m2 in the LRYGB group and 45.3 kg/m2 in the LSG group (Po0.003). Postoperatively, the mean BMI was reduced by 13.9 kg/m2/year and 12.3 kg/m2/year in LRYGB and LSG patients, respectively (P¼0.002). Postoperative mean total cholesterol, LDL, and triglyceride values were lower in LYRGB vs. LSG patients (Table). Postoperatively, 11% and 30% of LRYGB and LSG patients had a total cholesterol value 4200 mg/dL (Po0.001); 5% and 23% had LDL values 4130 mg/dL (Po0.001); and 8% and 10% had triglyceride levels above 130 mg/dL (P¼0.49). HDL values were within the recommended range in 95% and 92% of LRYGB and LSG patients, respectively (P¼0.58). Conclusions: Patients who underwent LRYGB had lower postoperative total cholesterol, LDL, and triglyceride values compared to those who underwent LSG. In patients with significant preoperative hypercholesterolemia who are candidates for both procedures, LRYGB may be more appropriate than LSG. A5082
MICRONUTRIENT DEFICIENCIES IN PATIENTS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) are common but poorly understood. Perioperative clinical practice guidelines recommend the same minimal daily nutritional supplementation for patients with LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, if LSG is less malabsorptive compared to LRYGB, LSG patients should require less dietary supplementation. The objective of this
Variable Albumin Ferritin Hemoglobin A1c Magnesium Parathyroid hormone Calcium Vitamin D Vitamin B12
LRYGB LSG N (%) with deficient values 75 / 126 (60) 9 / 12 (75) 66 / 275 (24) 14 / 79 (18) 33 / 256 (13) 4 / 52 (8) 6 / 95 (6) 0/23 (0) 35 / 210 (17) 3 / 35 (9) 5 / 277 (2) 0/74 (0) 90 / 238 (38) 17 / 45 (38) 30 / 287 (10) 24 / 74 (32)
P value 0.999 0.999 0.999 0.999 0.999 0.999 0.999 0.999
study is to compare the postoperative nutritional lab values in LSG and LRYGB patients to determine if LSG patients require altered supplementation. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2010 through 2013. Nutritional lab values obtained at 6-18 months postoperative were evaluated. All patients received recommendations for dietary supplementation consistent with clinical practice guidelines. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 444 and 121 patients identified who underwent LRYGB and LSG, respectively, with lab values available during the study period. The mean age at time of surgery was similar in the two groups at 46.7 years in the LRYGB group and 46.3 years in the LSG group. Mean preoperative BMI was 47.0 kg/ m2 and 45.1 kg/m2 in the LRYGB and LSG group, respectively. Postoperatively, the mean BMI was reduced by 13.8 kg/m2/year in the LRYGB group and 12.4 kg/m2/year in the LSG group. Postoperative mean nutrient values were similar in the two groups and there was no difference in the rate of nutrient deficiencies (Table). Conclusions: Nutritional deficiencies after LSG are common. Current clinical practice guideline adherence results in similar rates of deficiencies between LSG and LRYGB. Specifically, LSG patients still require supplementation with Vitamin B12 and iron. A5083
COMPARATIVE ANALYSIS OF BODY FAT PERCENTAGE VERSUS BODY MASS INDEX TO PREDICT WEIGHT LOSS AFTER BARIATRIC SURGERY Tara Mokhtari, BS; Sayantan Deb, BS; Lindsey Voller, BA; Sophia Koontz, BA; Dan Azagury, MD; Homero Rivas, MD, MBA; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Body mass index (BMI) has become the preferred anthropometric parameter in obesity and bariatric medicine as it provides a convenient, noninvasive approximation of body habitus. However, BMI is limited by its neglect of overall body composition. This study aims to examine the utility of body fat percentage (%BF) as an anthropometric parameter and investigates its efficacy to predict postoperative weight loss. Methods: From 03/2003 to 03/2015, 2209 patients undergoing laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding were prospectively enrolled. Demographic and
ultrasonography presented steatosis in 97 (54.4%) cases of mild steatosis, in 161 (67.6%) moderate steatosis and in 268 (80.4%) of severe steatosis, qui-square ¼ 38.573, P o0.001. Conclusion: It was observed an increase on ultrasonography sensibility as the degree of steatosis increase in this group of patients.
S97
ABC Study cohort LAGB
CPAP
P value
Pre-surgery Age
51.3 ± 8.9
48.4 ± 9.4
NS
Male %
47%
68%
NS
BMI
39.1 ± 2.8
38.9 ± 3.1
NS
Initial AHI
49.7 ± 24.8
48.9 ± 26.7
NS
8.9 ± 2.6
11.4 ± 5.1
NS
Reduction in BMI at 9-months
5.2 ± 2.6
0.7 ± 2.6
P<0.05
Improvement at AHI at 9-months
- 20.4 ± 26.0
- 6.6 ± 25.3
P<0.05
Improvement in effective AHI at 9-months
- 20.4 ± 26.0
- 26.9 ± 31.2
NS
Improvement in ESS score
- 2.2 ± 5.3
- 3.4 ± 4.6
NS
Initial ESS score Post-surgery
A5079
CORRELATION BETWEEN DYSLIPIDEMIA IMPROVEMENT AND CHANGES AT BODY FAT PERCENTAGE IN MORBIDLY OBESE PATIENTS SUBJECTED TO GASTRIC BYPASS Alexandre Padoin, MD PhD1; Felipe Laranjeira2; Luiza Lubianca, MD2; Rafael Ramos, MD3; Letícia Alves, MD MsC1; Cláudio Mottin, MD PhD1; 1Faculdade de Medicina e Serviço de Cirurgia Bariátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; 2Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; 3Serviço de Cirurgia Bariátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil Background: Body Mass Index although it`s practicality have limitations. The aim of this study is evaluate the correlation between dyslipidemia improvement and body fat percentage changes. Methods: We conducted an observational, retrospective cohort study of patients subjected to gastric bypass. We selected patients who underwent bioimpedance analysis and laboratory tests before surgery at 3, 6 and 12 months postoperatively. Results: We studied 228 patients with a mean age of 37.4 ⫾ 11.7 years old. Most patients were female (76.3%). Initially, 143 patients (66.2%) showed criteria for dyslipidemia, and 6 months after surgery, this number fell to 83 patients (50.6%) and continued falling over time to only 45 patients (28.5%) 12 months after surgery. In relating different variables with the decrease in percent body fat at 12 months, a significant association was seen with weight loss (r¼0.258; p¼0.009), BMI (r¼0.272; p¼0.005) and waist circumference (r¼0.357, p o0.001). However, the only biochemical parameter showing a significant association was HDL-C level (r¼-0.267; p¼0.009). Patients with the greatest decrease in body fat percentage were those with the largest decrease in weight, BMI and waist circumference and highest increase in HDL-C level. Conclusion: This study demonstrated the association of decrease in percent body fat with increase in HDL-C, regardless of sex and age. The same association was also observed when using the parameters BMI, weight loss and waist circumference. A5080
ABC STUDY: RESULTS OF THE FIRST US RANDOMIZED TRIAL OF BARIATRIC SURGERY FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA Ali Tavakkoli, MD; Wei Wang, PhD; Robert Andrews; Sanjay Patel, MD; Dept of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
Background: Obesity is the most common risk factor for obstructive sleep apnea (OSA) and current treatment with continuous positive airway pressure (CPAP) is often poorly tolerated. Bariatric surgery has been shown to improve OSA severity but these studies have primarily occurred in patients seeking weight loss surgery who are incidentally found to have OSA. We initiated an NIH-sponsored randomized trial of CPAP versus bariatric surgery as initial therapy in patients presenting to a sleep disorders clinic with symptomatic severe OSA (NCT01187771). Methods: Adult patients with severe OSA and body mass index (BMI) of 35-45 kg/m2 were recruited from two academically affiliated groups of sleep centers and randomized to either CPAP therapy or laparoscopic gastric banding surgery (LAGB). Followup evaluations to assess weight, OSA severity and OSA symptoms were performed at 9 months and 18 months following randomization by blinded observers. Results: Out of 481 patients meeting eligibility criteria, 97 (20%) attended an informational meeting and 53 enrolled in the study with 49 being randomized (Table 1). There were no major surgical complications. Incidences of adverse events between the 2 treatment groups were similar. LAGB patients had a greater degree of weight loss and reduction in apnea hypopnea index (AHI), although the improvement in effective AHI (AHI accounting for CPAP use) and Epworth Sleepiness Scale (ESS) were similar. Satisfaction with treatment assignment was similar between the 2 groups. The differences in outcomes were persistent at the 18month evaluation time point. Conclusion: LAGB is a viable alternative to CPAP at reducing AHI and improving OSA symptoms. Patient satisfaction and incidence of adverse events is similar between LAGB and CPAP. Further studies randomizing patients to more invasive surgeries with greater weight loss are needed and can be justified. A5081
IMPACT OF LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY ON POSTOPERATIVE LIPID VALUES Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Bariatric surgery has been shown to significantly improve many obesity-related comorbidities, including dyslipidemia. Previous research in the early postoperative period has demonstrated inconsistent results in lipid values after laparoscopic
S98
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211 Postoperative lipid values for LRYGB vs. LSG.
Lipid value, mg/dL
LRYGB
LSG
Nutrient deficiencies in patients after LRYGB vs. LSG P value
N
Mean ± SD
N
Mean ± SD
Total cholesterol
872
161.2 ± 30.6
71
184.2 ± 38.9
<0.001
LDL
860
84.3 ± 25.1
70
105.3 ± 33.8
<0.001
HDL
868
59.0 ± 14.0
71
60.3 ± 13.1
0.999
Triglycerides
866
90.1 ± 39.6
71
97.0 ± 40.3
0.600
Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG); with some indicating significantly greater reductions in total cholesterol and LDL in LRYGB vs. LSG, and others reporting no significant differences. Our objective was to evaluate the postoperative lipid values in LRYGB vs. LSG. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2001 through 2013. Lipid values available at 6-18 months postoperative were evaluated. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 872 and 71 patients who underwent LRYGB and LSG during the study period, respectively, for whom measurements of lipid values from 6-18 month postoperative period were available. The mean preoperative BMI was 47.3 kg/ m2 in the LRYGB group and 45.3 kg/m2 in the LSG group (Po0.003). Postoperatively, the mean BMI was reduced by 13.9 kg/m2/year and 12.3 kg/m2/year in LRYGB and LSG patients, respectively (P¼0.002). Postoperative mean total cholesterol, LDL, and triglyceride values were lower in LYRGB vs. LSG patients (Table). Postoperatively, 11% and 30% of LRYGB and LSG patients had a total cholesterol value 4200 mg/dL (Po0.001); 5% and 23% had LDL values 4130 mg/dL (Po0.001); and 8% and 10% had triglyceride levels above 130 mg/dL (P¼0.49). HDL values were within the recommended range in 95% and 92% of LRYGB and LSG patients, respectively (P¼0.58). Conclusions: Patients who underwent LRYGB had lower postoperative total cholesterol, LDL, and triglyceride values compared to those who underwent LSG. In patients with significant preoperative hypercholesterolemia who are candidates for both procedures, LRYGB may be more appropriate than LSG. A5082
MICRONUTRIENT DEFICIENCIES IN PATIENTS AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY Andrew Van Osdol, MD1; Andrew Borgert , PhD1; Kara Kallies, MS1; Shanu Kothari, MD, FACS2; Brandon Grover, DO2; 1Gundersen Medical Foundation, La Crosse, WI, USA; 2Gundersen Health System, La Crosse, WI, USA Background: Nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) are common but poorly understood. Perioperative clinical practice guidelines recommend the same minimal daily nutritional supplementation for patients with LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, if LSG is less malabsorptive compared to LRYGB, LSG patients should require less dietary supplementation. The objective of this
Variable Albumin Ferritin Hemoglobin A1c Magnesium Parathyroid hormone Calcium Vitamin D Vitamin B12
LRYGB LSG N (%) with deficient values 75 / 126 (60) 9 / 12 (75) 66 / 275 (24) 14 / 79 (18) 33 / 256 (13) 4 / 52 (8) 6 / 95 (6) 0/23 (0) 35 / 210 (17) 3 / 35 (9) 5 / 277 (2) 0/74 (0) 90 / 238 (38) 17 / 45 (38) 30 / 287 (10) 24 / 74 (32)
P value 0.999 0.999 0.999 0.999 0.999 0.999 0.999 0.999
study is to compare the postoperative nutritional lab values in LSG and LRYGB patients to determine if LSG patients require altered supplementation. Methods: A retrospective review of our prospective database was completed to identify patients who underwent either LRYGB or LSG at our institution from 2010 through 2013. Nutritional lab values obtained at 6-18 months postoperative were evaluated. All patients received recommendations for dietary supplementation consistent with clinical practice guidelines. Statistical analysis included Wilcoxon Rank Sum and χ2 tests with P values adjusted for multiple tests. A P value o0.05 was considered significant. Results: There were 444 and 121 patients identified who underwent LRYGB and LSG, respectively, with lab values available during the study period. The mean age at time of surgery was similar in the two groups at 46.7 years in the LRYGB group and 46.3 years in the LSG group. Mean preoperative BMI was 47.0 kg/ m2 and 45.1 kg/m2 in the LRYGB and LSG group, respectively. Postoperatively, the mean BMI was reduced by 13.8 kg/m2/year in the LRYGB group and 12.4 kg/m2/year in the LSG group. Postoperative mean nutrient values were similar in the two groups and there was no difference in the rate of nutrient deficiencies (Table). Conclusions: Nutritional deficiencies after LSG are common. Current clinical practice guideline adherence results in similar rates of deficiencies between LSG and LRYGB. Specifically, LSG patients still require supplementation with Vitamin B12 and iron. A5083
COMPARATIVE ANALYSIS OF BODY FAT PERCENTAGE VERSUS BODY MASS INDEX TO PREDICT WEIGHT LOSS AFTER BARIATRIC SURGERY Tara Mokhtari, BS; Sayantan Deb, BS; Lindsey Voller, BA; Sophia Koontz, BA; Dan Azagury, MD; Homero Rivas, MD, MBA; John Morton, MD; Stanford School of Medicine, Stanford, CA, USA Introduction: Body mass index (BMI) has become the preferred anthropometric parameter in obesity and bariatric medicine as it provides a convenient, noninvasive approximation of body habitus. However, BMI is limited by its neglect of overall body composition. This study aims to examine the utility of body fat percentage (%BF) as an anthropometric parameter and investigates its efficacy to predict postoperative weight loss. Methods: From 03/2003 to 03/2015, 2209 patients undergoing laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding were prospectively enrolled. Demographic and