Author's Accepted Manuscript

Comparative Effectiveness of Three Bariatric Sur-

gery Procedures: Roux-en-Y Gastric Bypass, La-
paroscopic Adjustable Gastric Band, and Sleeve
Gastrectomy
Jenny H. Lee PharmD, Quynh-Nhu Nguyen PharmD,
BCACP, Quang A. Le PharmD, PhD

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PII: S1550-7289(16)00025-3
DOI: http://dx.doi.org/10.1016/j.soard.2016.01.020
Reference: SOARD2547

To appear in: Surgery for Obesity and Related Diseases

Cite this article as: Jenny H. Lee PharmD, Quynh-Nhu Nguyen PharmD, BCACP, Quang
A. Le PharmD, PhD, Comparative Effectiveness of Three Bariatric Surgery Procedures:
Roux-en-Y Gastric Bypass, Laparoscopic Adjustable Gastric Band, and Sleeve
Gastrectomy, Surgery for Obesity and Related Diseases, http://dx.doi.org/10.1016/j.
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 Comparative Effectiveness of Three Bariatric Surgery Procedures: Roux-en-Y

Gastric Bypass, Laparoscopic Adjustable Gastric Band, and Sleeve Gastrectomy

Jenny H. Lee, PharmDa, Quynh-Nhu Nguyen, PharmD, BCACPb, Quang A. Le, PharmD,

PhDa,b,*
a
Western University of Health Sciences, Pomona, California
b
Veterans Affairs Loma Linda Health Systems, Loma Linda, California

*Corresponding Author and Reprints:

Quang A. Le, Pharm.D., Ph.D.
Western University of Health Sciences
309 E. Second Street
Pomona, CA 91766-1854
Phone: 909-706-3821
Fax: 909-469-5428
Email: qle@westernu.edu

Keywords: Comparative Effectiveness, Bariatric Surgery Procedures, Roux-en-Y Gastric

Bypass, Laparoscopic Adjustable Gastric Band, Sleeve Gastrectomy, US Veterans.

Acknowledgements of Research Support: There are no conflicts of interest and no financial

support provided by any source for this study. Primary findings of this study to be presented in

part at the ObesityWeek from the American Society for Metabolic and Bariatric Surgery

(ASMBS) in Los Angeles, CA, November 4th 6th, 2015.

Running Title: Comparative Effectiveness of Bariatric Procedures.

1
 ABSTRACT

Background: Bariatric surgery is associated with improved comorbidities, quality of life and

survival in severely obese patients. Common bariatric surgery procedures include Roux-en-Y

gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and sleeve gastrectomy

(SG). Currently, comparative effectiveness evidence on different bariatric surgery procedures in

veterans is limited.

Objectives: To compare effectiveness of three bariatric surgery procedures performed in

veterans.

Setting: Veterans Affairs Hospital, United States.

Methods: This study was a single-institution, retrospective cohort study. Primary outcome was

weight reduction, expressed as kilogram lost, body mass index (BMI) reduction, percentage

weight loss (%WL), and percentage excess weight loss (%EWL) following 12 months of

bariatric surgery. Secondary outcomes were reduction in number of medications and laboratory

markers for obesity-related chronic conditions. Inverse-probability weighting propensity score

method was used to balance baseline characteristics among the procedures.

Results: A total of 162 patients were included in the study. At 12 months, the kilogram lost,

BMI reduction, %WL, and %EWL were 40.714.5kg, 13.44.1kg/m2, 31.58.5% and

41.411.6% for RYGB; 24.422.1kg, 7.97.3kg/m2, 20.221.5% and 26.727.6% for SG; and

15.315.7kg, 5.05.0kg/m2, 12.011.7% and 16.115.9% for LAGB, respectively (RYGB vs.

SG, RYGB vs. LAGB, and SG vs. LAGB, all Ps < 0.01). The reduction in number of

medications, total cholesterol, and low-density lipoprotein (LDL) also showed significant

improvement with RYGB.

2
Conclusions: For short-term, RYGB appears to achieve better weight reduction and

management of obesity-associated comorbid conditions compared to the SG and LAGB

procedures in veteran patients. SG could be the next alternative over LAGB for bariatric surgery

procedure in patients who are not candidates for RYGB.

Introduction

Obesity has become a national epidemic, affecting people of all ethnicities, ages, and gender(1,2).

Approximately 35% or over 78 million of the adult population are considered to be obese in the

U.S.(1,2). Consequently, the increased prevalence of obesity has contributed to numerous and

varied comorbid conditions such as diabetes, stroke, cardiovascular diseases, gallbladder disease,

osteoarthritis, sleep apnea, and certain types of cancer, as well as negative effect on quality of

life(2,3).

The effectiveness and safety of bariatric surgery have been well-established, especially in

patients with morbid obesity, in terms of weight reduction, obesity-associated comorbidities, and

quality of life(4-7). In addition, recent evidence has also shown bariatric surgery achieved better

long-term survival than non-surgery treatments(8-12). The most common bariatric surgery

procedures include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band

(LAGB), and sleeve gastrectomy (SG). RYGB is a procedure that constructs a small pouch from

the proximal portion of the stomach attaching it directly to the small intestine. It bypasses part of

the stomach and duodenum. LAGB is a reversible procedure in which an inflatable band is

placed around the proximal part of the stomach to create a small pouch. The band can be

adjusted to increase or decrease restriction according to patients needs. SG is one of the newest

3
surgical techniques which involves removing a large portion of the stomach. However, no

intestines are removed or bypassed in this procedure(13).

Studies have shown that RYGB, even though more invasive, has achieved better clinical

outcomes than the SG and LAGB procedures. However, there are few observational studies and

no randomized controlled trials that compare the effectiveness and management of obesity-

associated comorbidities of these three procedures(14-20). In addition, current comparative

effectiveness evidence of different bariatric surgery procedures in veteran patients is limited.

Different from the general population, the veteran population is unique in terms of gender ratio,

average age, and comorbid conditions. The primary objective of the current study was to

determine the comparative effectiveness of the three bariatric surgery procedures on weight

reduction in the U.S. veteran population. Our secondary objectives were to compare changes in

number of chronic medications and laboratory markers associated with obesity comorbidities

related to these bariatric surgery procedures.

Materials and Methods

This study was a single-institution, retrospective cohort study at a Veterans Affairs (VA) medical

center with the specialty in bariatric surgery. Data collection was carried out by utilizing the VA

Computerized Patient Record System. The Institutional Review Board (IRB) committees from

the VA medical center as well as our institution have approved the study.

Patients

We initially identified patients if they had a bariatric surgery consultation. Patients who were 18

years of age or older and underwent bariatric surgery between August 1, 2006 and February 1,

4
2014 at the VA medical center were included in the study. We excluded patients who received

their bariatric surgeries outside the VA hospital.

Outcomes

The primary outcome was weight reduction, expressed as kilogram (kg) lost, Body Mass Index

(BMI) reduction, percentage weight loss (%WL), and percentage excess weight loss (%EWL)

following 6 and 12 months of bariatric surgery. The ideal body weight was defined as the median

weight for height of medium frame in the Metropolitan Life Insurance Tables(21).

Secondary outcomes were reduction in number of chronic medications prescribed and laboratory

markers for obesity-related chronic conditions (diabetes, hypertension, dyslipidemia, and

gastroesophageal reflux disease) at 6- and 12-month follow-up. Laboratory markers associated

with obesity included fasting blood glucose (mg/dL), HbA1C, total cholesterol (mg/dL), LDL

cholesterol (mg/dL), HDL cholesterol (mg/dL), triglycerides (mg/dL), and blood pressure

(mmHg).

Statistical Analysis

In our study, patients were not randomized to receive a certain bariatric surgery procedure

(RYGB, LAGB, or SG); thus, a number of important observed baseline clinical and demographic

characteristics were essentially different among the bariatric procedures. Propensity score

weighting is an effective method used in observational studies to reduce bias and balance

differences in the observed baseline characteristics among the three bariatric surgery

procedures(22,23). We fitted a propensity-score model with the observed baseline characteristics

including age, gender, race, weight, BMI, glucose, and the Charlson Comorbidity Index (CCI)

using the R package TWANG(24,25). The propensity scores were carried out to estimate the

5
inverse probability of treatment weights (IPTW) for each patient included in our study(24,25). To

analyze weighted data, we used the R package SURVEY(24-26) to estimate treatment effects of the

bariatric procedures on the primary and secondary outcomes. Similar to randomized control trials

(RCTs), the IPTW propensity-score method eliminates the observed confounders by comparing

the primary and secondary outcomes among patients receiving the three bariatric surgery

procedures who have a similar distribution of their observed baseline characteristics(22,23).

Continuous data were expressed as means their standard deviations and categorical variables

were presented as numbers with their percentages in parentheses. The significance threshold was

set at P = 0.05. Differences at baseline among the three bariatric surgery procedures were

analyzed using one-way ANOVA and chi-squared tests for continuous and categorical data,

respectively. Pairwise comparisons of the outcomes between the bariatric surgery procedures, i.e.

RYGB vs. SG, RYGB vs. LAGB, and SG vs. LAGB, were reported using unpaired t-test. All

statistical analyses were performed with R statistical Software (R Foundation for Statistical

Computing, Vienna, Austria)(27).

Results

Baseline Characteristics

A total of 336 veteran patients were initially screened, of which 174 patients were excluded (120

patients did not receive bariatric surgery and 54 patients underwent surgery outside the VA

medical center) leaving162 to be included in the study. There were 84 patients who underwent

the RYGB procedure, 48 patients received SG, and 30 patients had LAGB. Regarding the

surgical technique, laparoscopic method was the primary technique performed in all three

bariatric procedures (RYGB: 96.4% laparoscopic vs. 3.6% open; SG: 97.9% laparoscopic vs.

6
2.1% open; and LAGB: 100% laparoscopic). The study sample had a mean age of 55.29.2

years, of which 113 patients (69.3%) were male and 99 patients (61.1%) were of Caucasian

origin. Overall, the VA patients had a mean body mass index (BMI) of 42.95.2 with the mean

Charlson Comorbidity Index of 1.41.5. Three patients died during the 12-month follow-up after

surgery. Of these three patients, two died in RYGB group due to surgery related complications

(sepsis), and one patient died in LAGB group due to bacterial endocarditis and acute respiratory

distress syndrome months after the surgery. The short-term surgery complication rates for

RYGB, SG, and LAGB were 11.9%, 6.3%, and 0% (P = 0.104) for surgery-related hospital

readmission and 16.7%, 14.6%, and 10.0% (P = 0.677) for surgery-related emergency room visit

without hospitalization within 30 days after the bariatric surgery, respectively.

Table 1 presented the baseline demographic and clinical characteristics among patients who

received RYGB, LAGB, or SG procedure before and after balancing with the IPTW propensity-

score method. Prior to the adjustment, significant differences were observed in patients age,

gender, and glucose levels (P = 0.004, P = 0.001, and P = 0.027, respectively) among the three

surgical procedures at the baseline. After adjusting using the IPTW propensity-score method, all

the observed demographic and clinical characteristics were balanced with no statistically

significant differences among the three bariatric surgery procedures (all Ps > 0.05) (Table 1).

Weight Reduction

The follow-up rates at 6 and 12 months in the RYGB, SG, and LAGB groups were 96.4% and

96.4%, 97.9% and 89.6%, and 96.7% and 76.7%, respectively. Overall, at 6-month and 12-

month follow-up, the RYGB procedure achieved the most weight loss in kg, BMI reduction,

%WL, and %EWL (P < 0.001 for all pairwise comparisons), followed by the SG procedure, and

LAGB yielded the least weight loss (Table 2).

7
Obesity Related Comorbid Conditions

At 6 months, on average the reduction in number of prescribed medications for chronic

conditions from baseline for RYGB, SG, and LAGB were 2.83.4, 1.72.9, and 1.32.9,

respectively (RYGB vs. SG, P = 0.007; RYGB vs. LAGB, P < 0.001; and SG vs. LAGB, P =

0.384). At 12 months, the mean reduction in number of chronic medications for RYGB, SG, and

LAGB were 3.23.3, 1.83.2, and 1.12.8 respectively (RYGB vs. SG, P = 0.001; RYGB vs.

LAGB, P < 0.001; and SG vs. LAGB, P = 0.149) (Table 3).

There were no significant differences in glucose, A1C, triglycerides, and diastolic blood pressure

among the three bariatric procedures at 6-month and 12-month follow-up (all Ps > 0.05).

Patients underwent RYGB and LAGB achieved significantly lower total cholesterol and LDL

level than those with SG procedure at follow-up (P < 0.05) (Table 3).

Discussion

With the increased prevalence of obesity and its associated comorbid medical conditions, the

number of bariatric surgeries performed in the United States was up more than 50% within 2

years between 2011 and 2013(28). Even with its increasing popularity, comparative effectiveness

evidence among the most common bariatric surgery procedures in the U.S., especially in the

veteran population, is limited. In the current study, we investigated the short-term outcomes of

weight loss and obesity-associated comorbid disease management in terms of reduction in

number of chronic medications and laboratory markers related to obesity in the three common

bariatric surgery procedures (RYGB, SG, and LAGB).

For short-term weight loss measured by kilogram lost, BMI reduction, %WL, and %EWL, the

RYGB procedure was superior to both SG and LAGB procedures at 6- and 12-month follow-up

8
after surgery. Alternatively, SG appeared to achieve better outcomes as compared to the LAGB

procedure. In terms of managing comorbidities, reduction in number of prescribed medications

associated with obesity-related conditions from the baseline also followed a similar trend as the

effect of weight loss. RYGB was the most effective in reducing the number of chronic

medications when compared to SG and LAGB. Furthermore, RYGB also showed the most

favorable outcomes in the laboratory markers associated with comorbid conditions related to

obesity with the exception of HDL cholesterol. It should be noted that although there was no

statistical significance, the surgery-related hospital readmission rate appeared higher in patients

who received the RYGB procedure and two patients died of surgery-related complications.

Overall, our results appeared to be consistent with evidence from nonveteran populations(14-20).

Strain et al.(18) showed similar outcomes in which 70.4% EWL was seen in gastric bypass

procedure, 49% in sleeve gastrectomy, and 37.7% for adjustable gastric band. In Hutter et al.(17),

the authors found that reduction in BMI and obesity-related comorbidities from the SG

procedure were in between the RYGB and LAGB procedures. More recently, Dogan et al.(14)

reported that RYGB was comparable to SG in both %EWL and BMI reduction, while LAGB

was inferior to both RYGB and SG procedures. Nevertheless, even though these studies tried to

match patients with their age and gender, their baseline clinical characteristics among the

bariatric procedures were not balanced and statistically significant differences were still observed

at baseline such as patients BMI measures and baseline comorbidity profile. As a result, it might

have caused bias and affected their outcome results. The %EWL observed in the current study

were relatively lower than values reported by other studies. However, the %EWL would depend

on both pre-surgery factors, i.e. patients clinical and demographic characteristics, as well as

post-surgery factors, i.e. diet and lifestyle modifications. It was likely that our VA patients were

9
different from other patient populations in terms of baseline demographic characteristics and

existing comorbidities, including mental health conditions, that might have impacted on

achieving their maximal weight loss.

Due to the observational nature of our study, many confounding factors may exist that would

yield incorrect interpretation of the data. To address the issue, we applied the IPTW propensity-

score method to balance the observed baseline demographic and clinical characteristics among

the three bariatric surgery procedures; therefore, the surgery outcomes were properly compared.

Similar to our study, using propensity-score matching method the Carlin et al.(16) also found that

the degree of weight loss and comorbid condition remission were greatest with RYGB, followed

by SG and then LAGB. The main difference in study by Carlin et al. could be attributed to

different studied patient populations, i.e. our study only included veteran population who were

older with majority of male patients but had less comorbid conditions and better BMI measures;

thus might affect the degree of weight loss.

There were still few external factors that might not be adjusted due to the nature of the study.

Potential selection bias by surgeons as to which procedure to perform and their experience could

not be controlled in our study. Equally important, patients diet and lifestyles after their

surgeries, a factor that might have potentially great impact on clinical outcomes, was not

controlled. In addition, other factors such as liver size, previous surgery/adherence,

gastroesophageal reflux or abdominal wall hernias that were not controlled for in our study might

potentially impact the outcomes. As a result, these factors remain the limitations of our study.

Only a RCT can truly minimize both observed and unobserved confounding variables that can

affect the outcome results. Therefore, a RCT with long follow-up time of the three procedures is

imperative to determine the true-lasting effect of these bariatric procedures on obese veterans.

10
In summary, the current study was the first to examine the short-term effectiveness of weight

reduction and comorbid-condition management among the three most common bariatric surgery

procedures in U.S. veteran patients. The results of our study are generally consistent with

outcomes from non-veteran populations in which the RYGB procedure achieved the most weight

reduction as compared to the LAGB and SG procedures. However, the degree of weight loss

among the bariatric procedures in U.S. veteran patients were somewhat lower than non-veteran

patients. As a result, interpretation of the current study should be limited to the veteran

population as they are unique and different from other populations in terms of gender ratio,

average age, and comorbid conditions.

Conclusions

In the veteran population, the RYGB procedure appears to achieve better short-term outcomes in

terms of weight reduction and management of obesity-associated comorbid conditions as

compared to the SG and LAGB procedures. SG may be the next best option for bariatric surgery

in patients who are not candidates for RYGB.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to

this article.

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Table 1. Baseline clinical and demographic characteristics

Unweighted (Prior to P-S RYGB SG LAGB
P-values
Adjustment) (n = 84) (n = 48) (n = 30)
Age*, year (mean SD)* 53.4 9.4 56.6 9.7 58.0 6.8 0.004
Weight, kg (mean SD) 129.8 20.5 131.0 20.9 136.4 23.2 0.236
BMI, kg/m2 (mean SD) 43.0 5.2 42.9 5.6 42.7 5.0 0.637
Gender* - male, n (%) 49 (58.3%) 38 (79.2%) 26 (86.7%) 0.001
Race - Caucasian, n (%) 57 (67.9%) 25 (52.1%) 17 (56.7%) 0.077
CCI Score (mean SD) 1.3 1.5 1.5 1.6 1.3 1.6 0.564
Glucose*, mg/dL (mean SD) 101.8 28.7 108.5 57.0 123.7 59.4 0.027
HbA1c, % (mean SD) 5.6 0.5 5.9 0.5 5.8 0.7 0.068
Total Cholesterol, mg/dL (mean 167.5 37.5 182.5 35.4 164.2 31.4 0.867
SD)
LDL Cholesterol, mg/dL (mean 100.7 33.6 117.0 29.1 96.8 24.5 0.822
SD)
HDL Cholesterol, mg/dL (mean 44.9 17.3 41.0 7.9 43.1 11.6 0.378
SD)
Triglycerides, mg/dL (mean SD) 110.9 62.8 126.6 61.9 126.3 74.2 0.283
Systolic Blood Pressure, mmHg 124.6 13.9 122.4 13.3 130.5 18.1 0.322
(mean SD)
Diastolic Blood Pressure, mmHg 74.8 9.7 76.1 10.3 72.2 19.9 0.705
(mean SD)
Weighted (After P-S
RYGB1 SG2 LAGB3 P-values
Adjustment)
Age, year (mean SD) 54.1 11.7 55.5 15.3 57.4 13.0 0.062
Weight, kg (mean SD) 130.3 28.4 130.5 36.6 132.3 42.7 0.709
BMI, kg/m2 (mean SD) 42.8 6.7 42.8 8.7 41.9 7.9 0.420
Gender - male (%) 63.7% 76.3% 82.4% 0.055
Race - Caucasian (%) 66.7% 58.1% 59.8% 0.360
CCI Score (mean SD) 1.4 1.9 1.4 2.4 1.4 2.9 0.808
Glucose, mg/dL (mean SD) 100.7 32.0 105.6 75.6 112.9 73.6 0.160
*P < 0.05
1
Sum of weights for RYGB = 122; 2Sum of weights for LSG = 111; 3Sum of weights for LAGB = 84
BMI: Body mass index; CCI: Charlson Comorbidity Index; HbA1c: glycated hemoglobin; HDL: high-density
lipoprotein; IPTW: Inverse Probability of Treatment Weights; LAGB: laparoscopic gastric binding; LDL: low-
density lipoprotein; P-S: Propensity Score; RYGB: Roux-en-Y Gastric Bypass; SD: standard deviation; SG:
laparoscopic sleeve gastrectomy

15
Table 2. Primary Outcomes for Weight Reduction
RYGB vs. RYGB vs. SG vs.
RYGB SG LAGB SG LAGB LAGB
P-values P-values P-values

Kilogram Lost (mean

SD)
34.0 23.5 14.0 < 0.001 < 0.001
6 Months Post Surgery < 0.001
12.9 17.9 14.1
40.7 24.4 15.3 < 0.001 0.001
12 Months Post Surgery < 0.001
14.5 22.1 15.7
BMI Reduction (mean
SD)
11.1 < 0.001 < 0.001 < 0.001
6 Months Post Surgery 7.8 6.1 4.4 4.5
4.0
13.4 < 0.001 < 0.001 0.001
12 Months Post Surgery 7.9 7.3 5.0 5.0
4.1
%WL (% SD)
26.0 18.5 10.3 < 0.001 < 0.001 < 0.001
6 Months Post Surgery
7.2 13.7 10.4
31.5 20.2 12.0 < 0.001 < 0.001 < 0.001
12 Months Post Surgery
8.5 21.5 11.7
%EWL (% SD)
34.2 24.6 13.9 < 0.001 < 0.001 < 0.001
6 Months Post Surgery
9.4 18.2 14.3
41.4 26.7 16.1 < 0.001 < 0.001 < 0.001
12 Months Post Surgery
11.6 27.6 15.9
%EWL: percent excess weight loss; %WL: percent weight loss; BMI: body mass index; Kg: kilogram; LAGB:
laparoscopic gastric binding; RYGB: Roux-en-Y Gastric Bypass; SD: standard deviation; SG: sleeve gastrectomy

16
Table 3. Secondary Outcomes: Reductions in Number of Medications and Laboratory Markers for
Obesity-Related Comorbid Conditions
RYGB vs. RYGB vs. SG vs.
RYGB SG LAGB SG LAGB LAGB
P-values P-values P-values
Reduction in Number of
Medications (mean SD)
6 Months Post Surgery 2.8 3.4 1.7 2.9 1.3 2.9 0.007 < 0.001 0.384
12 Months Post Surgery 3.2 3.3 1.8 3.2 1.1 2.8 0.001 < 0.001 0.149
Glucose, mg/dL (mean SD)
100.3 99.2 105.2 0.494 0.388
6 Months Post Surgery 0.802
36.7 29.8 57.3
97.3 104.6 105.6 0.176 0.887
12 Months Post Surgery 0.080
17.0 40.8 54.5
HbA1C, % (mean SD)
6 Months Post Surgery 5.8 1.3 5.9 1.2 5.9 1.2 0.463 0.797 0.673
12 Months Post Surgery 5.7 0.9 5.8 1.2 5.9 0.9 0.726 0.277 0.559
Total Cholesterol, mg/dL (mean
SD)
164.6 186.2 165.3 0.922 0.013
6 Months Post Surgery 0.003
45.9 62.0 53.9
161.7 188.8 168.4 0.335 0.027
12 Months Post Surgery 0.002
46.3 76.3 50.7
LDL Cholesterol, mg/dL (mean
SD)
102.2 116.9 101.9 0.964 0.050
6 Months Post Surgery 0.027
40.3 57.9 48.4
90.3 116.4 99.6 0.137 0.049
12 Months Post Surgery < 0.001
39.9 70.9 46.9
HDL Cholesterol, mg/dL (mean
SD)
41.1 46.2 42.2 0.758 0.287
6 Months Post Surgery 0.017
12.2 18.4 29.9
48.2 50.5 46.0 0.537 0.294
12 Months Post Surgery 0.488
18.0 31.4 28.7
Triglycerides, mg/dL (mean SD)
117.0 115.3 112.0 0.702 0.824
6 Months Post Surgery 0.895
81.2 109.9 100.7
105.0 107.8 114.4 0.597 0.699
12 Months Post Surgery 0.812
98.5 79.8 140.1
SBP, mmHg (mean SD)
125.4 129.1 124.3 0.799 0.398
6 Months Post Surgery 0.453
26.1 45.7 34.1
122.8 130.0 134.3 0.030 0.484
12 Months Post Surgery 0.118
25.6 41.3 42.6
DBP, mmHg (mean SD)
75.6 77.1 76.5 0.761 0.851
6 Months Post Surgery 0.585
17.5 23.0 21.8
74.5 78.4 76.5 0.495 0.541
12 Months Post Surgery 0.134
18.2 20.9 22.0

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DBP: diastolic blood pressure; HDL: high-density lipoprotein; LAGB: laparoscopic gastric binding; LDL: low-
density lipoprotein; RYGB: Roux-en-Y Gastric Bypass; SBP: systolic blood pressure; SD: standard deviation; SG:
sleeve gastrectomy

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