Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Obesity and Diabetes Mellitus: Psychology and Quality of Life Outcomes at 10 Years

Background Obesity impacts physical, physiological and psychological domains of life. The long-term effects of metabolic bariatric surgery (MBS) on patient-centred outcomes such as mental health and quality of life (QOL) may enhance the management of obesity and the application of MBS. Methods A prospective, blinded, double arm, parallel, randomised trial was carried out at a single bariatric centre in Waitemata, New Zealand. Adults with type 2 diabetes mellitus and obesity were randomised 1:1 to undergo laparoscopic sleeve gastrectomy (SG) or silastic ring Roux-en-Y gastric bypass (SR-RYGB). After unblinding at 5 years, patients were followed up at 10 years. This analysis focuses on secondary outcomes: Hospital Anxiety and Depression Scale (HADS) scores and RAND-36 QOL scores. Results Of 114 patients randomised, 80 patients (70.2%) completed 10-year follow up (39 SG; 41 SR-RYGB). SR-RYGB was associated with greater weight loss (33.3 kg vs. 25.8 kg, p = 0.031) and trended towards higher diabetes remission (31.7% vs. 23.1%, adjusted OR 2.07, 95% CI 0.70, 6,10, p = 0.186). Mean HADS anxiety score for SG decreased by 1.59 units over 10-years ( p = 0.027). Improvements in RAND-36 scores were significantly greater after 10 years for SR-RYGB than SG for physical function (19 vs. 12 points, p = 0.026) and general health (17 vs. 10 points, p = 0.036). Role limitation due to emotional problems worsened significantly by 16 points for the SG group ( p = 0.032). Conclusion SR-RYGB demonstrated superior long-term improvements in physical function and general health QOL domains of RAND-36 compared to SG. Anxiety symptoms may be reduced long-term following SG.