Key result
Roux-en-Y gastric bypass achieves ~63% excess BMI loss, beating sleeve gastrectomy at five years.
Why the study?
LSG and LRYGB are both effective surgical procedures for weight reduction in patients with obesity, prompting a comparison of outcomes using merged individual-patient data from two RCTs.
Does Laparoscopic Roux-en-Y gastric bypass improve percentage excess BMI loss compared to laparoscopic sleeve gastrectomy in patients with obesity?
Meta-Analysis (n=457)
Yes
Does Laparoscopic Roux-en-Y gastric bypass improve percentage excess BMI loss compared to laparoscopic sleeve gastrectomy in patients with obesity?
LRYGB induced greater weight loss and better amelioration of hypertension than LSG at 5 years, though with a higher complication rate.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are both effective surgical procedures to achieve weight reduction in patients with obesity. The trial objective was to merge individual-patient data from two RCTs to compare outcomes after LSG and LRYGB. METHODS: Five-year outcomes of the Finnish SLEEVEPASS and Swiss SM-BOSS RCTs comparing LSG with LRYGB were analysed. Both original trials were designed to evaluate weight loss. Additional patient-level data on type 2 diabetes (T2DM), obstructive sleep apnoea, and complications were retrieved. The primary outcome was percentage excess BMI loss (%EBMIL). Secondary predefined outcomes in both trials included total weight loss, remission of co-morbidities, improvement in quality of life (QoL), and overall morbidity. RESULTS: At baseline, 228 LSG and 229 LRYGB procedures were performed. Five-year follow-up was available for 199 of 228 patients (87.3 per cent) after LSG and 199 of 229 (87.1 per cent) after LRYGB. Model-based mean estimate of %EBMIL was 7.0 (95 per cent c.i. 3.5 to 10.5) percentage points better after LRYGB than after LSG (62.7 versus 55.5 per cent respectively; P < 0.001). There was no difference in remission of T2DM, obstructive sleep apnoea or QoL improvement; remission for hypertension was better after LRYGB compared with LSG (60.3 versus 44.9 per cent; P = 0.049). The complication rate was higher after LRYGB than LSG (37.2 versus 22.5 per cent; P = 0.001), but there was no difference in mean Comprehensive Complication Index value (30.6 versus 31.0 points; P = 0.859). CONCLUSION: Although LRYGB induced greater weight loss and better amelioration of hypertension than LSG, there was no difference in remission of T2DM, obstructive sleep apnoea, or QoL at 5 years. There were more complications after LRYGB, but the individual burden for patients with complications was similar after both operations.
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Wölnerhanssen et al. (2020) conducted a meta-analysis in Obesity (n=457). Laparoscopic Roux-en-Y gastric bypass (LRYGB) vs. Laparoscopic sleeve gastrectomy (LSG) was evaluated on Percentage excess BMI loss (%EBMIL) (Mean difference 7.0 percentage points, 95% CI 3.5 to 10.5, p=<0.001). Laparoscopic Roux-en-Y gastric bypass induced greater percentage excess BMI loss than laparoscopic sleeve gastrectomy at 5 years (62.7% vs 55.5%; P<0.001).
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