Laparoscopic Gastric Bypass Versus Sleeve Gastrectomy to Treat Morbid Obesity
Laparoscopic Gastric Bypass Versus Sleeve Gastrectomy to Treat Morbid Obesity
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.
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.
Inclusion Criteria:

 -  BMI > 40 or BMI > 35 with a comorbidity associated with obesity

 -  Age 18 - 60 years

 -  Failed prior effective and controlled conservative treatments of morbid obesity

 Exclusion Criteria:

 -  BMI > 60

 -  Difficult psychiatric conditions or lack of co-operation

 -  Difficult eating disorder (binge eating, bulimia etc.)

 -  Alcohol abuse

 -  Gastric ulcer