Two-year results of laparoscopic sleeve gastrectomy and Roux-En-Y Gastric Bypass in patients with morbid obesity

Objective: To compare the long-term results of LSG and RYGB with a fixed restrictive component in patients with morbid obesity in terms of weight loss, control of associated diseases and the development of long-term complications, including sarcopenia. Materials and methods: our study included the results of treatment of 251 patients (153 LSG and 98 RYGB). The follow-up period was at least 24 months (median follow-up 38 months). The restrictive component was assessed 12 months after surgery using CT-volumetry. The size of the gastroenetroanastomosis was additionally measured using fibrogastroscopy in the RYGB group. The bioelectrical impedance analysis (BIA) was used to assess body composition and determine the skeletal muscle mass index (SMMI) initially and during control examinations in the postoperative period. Results: both groups obtained good results in terms of weight loss and control of associated diseases, however, RYGB shows some advantages in these parameters. On the other hand, in the RYGB group a higher rate of progression of signs of sarcopenia was detected (8.2% (including 3% of severe sarcopenia) vs 3.3% in the LSG group). Most patients who progressed to sarcopenia were older, had type 2 diabetes mellitus (T2DM), or had mild sarcopenia at baseline. Conclusions: RYGB demonstrates better results in terms of weight loss and control of associated diseases compared to LSG, however, in elderly patients, as well as in the presence of T2DM or signs of sarcopenia, it is advisable to choose operations without a pronounced malabsorptive effect.