Laparoscopic Gastric Bypass Versus Sleeve Gastrectomy to Treat Morbid Obesity
Condition: Morbid Obesity
MeSH terms: Obesity; Obesity, Morbid
Study type: Observational

Summary: 
      Bariatric surgery in the treatment of morbid obesity is associated with long-term weight-loss
      and decreased overall mortality. Long-term results have been reported for laparoscopic
      gastric bypass procedures but the long-term results of laparoscopic sleeve gastrectomy are
      yet unavailable. As sleeve gastrectomy is a rapid and less traumatic procedure with good
      short-term results of weight loss and resolution of comorbidities, the investigators
      initiated a prospective randomized two-center study comparing laparoscopic sleeve gastrectomy
      (LSG)with laparoscopic gastric bypass (LGB) in the treatment of morbid obesity. Study
      hypothesis: As sleeve gastrectomy is less traumatic, easier and faster to perform compared
      with gastric bypass,LSG could become the procedure of choice to treat morbid obesity if the
      long-term results of weight loss and resolution of comorbidities are comparable with
      laparoscopic gastric bypass.
    

Detailed description: 
      In addition to comparing the outcomes between sleeve gastrectomy and gastric bypass, the
      study project includes a PET trial conducted in Turku. The objectives of this PET study are
      to measure effect of obesity on food-stimuli mediated brain activation response and on
      hormones affecting both feeding and energy balance. In the second part the same variables are
      studied after bariatric surgery: either laparoscopic sleeve gastrectomy or Roux-en-Y gastric
      bypass. In addition the effect of weight loss due to bariatric surgery on glucose uptake and
      free fatty acid metabolism is measured. The objective is also to study whether less invasive
      sleeve gastrectomy is as beneficial in terms of weight loss and co-morbid diseases as more
      invasive Roux-en-Y gastric bypass and to compare the risk factors between these two surgical
      procedures. Regional glucose uptake and free fatty acid uptake in myocardium, skeletal
      muscle, subcutaneous fat, visceral fat, pancreas, liver and brain are studied with PET at
      baseline before bariatric surgery and post-operatively on the 3rd month. Changes in body fat
      distribution, in ectopic fat and fat content of key organs are investigated with magnetic
      resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Brain reward system
      response to food stimuli is assessed using functional MRI (fMRI) and white and grey matter
      volumes using diffusion tensor imaging (DTI).

      The study consists of 80 morbidly obese adults, BMI ≥ 40 kg/m2 or if there is additional risk
      factor BMI ≥ 35 kg/m2. From these subjects, 40 are further studied with positron emission
      tomography (PET) and magnetic resonance imaging (MRI). In addition functional MRI (fMRI) will
      be performed for 40 subjects. For fMRI, a control group is recruited consisting of 20 lean
      and healthy subjects. Subjects are physically examined and anthropometric data are measured
      along with blood sampling.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients rederred to three tertiary referral hospitals (Turku University Central Hospital,
        Vaasa Central Hospital and Peijas Hospital)for treatment of morbid obesity
      
Biospecimen description: 
      Tissue samples
    
Keywords: morbid obesity; laparoscopic sleeve gastrectomy; LSG; laparoscopic gastric bypass; LGB; comorbidities; diabetes; excessive weight loss; weight loss