Key result
Roux-en-Y gastric bypass linked to ~4% greater 7-year total weight loss versus sleeve gastrectomy.
Why the study?
Limited long-term data compare the outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass for severe obesity regarding body weight, quality of life, and comorbidities.
Does sleeve gastrectomy compared to Roux-en-Y gastric bypass result in different 7-year trajectories of weight loss, quality of life, and comorbidities in patients with severe obesity?
Observational (n=543)
Yes
Does sleeve gastrectomy compared to Roux-en-Y gastric bypass result in different 7-year trajectories of weight loss, quality of life, and comorbidities in patients with severe obesity?
Mean Difference: 3.9 (95% CI 2–5.7)
Absolute Event Rate: 27.3% vs 23.4%
p-value: p=0.001
Roux-en-Y gastric bypass provides superior long-term weight loss and comorbidity remission compared to sleeve gastrectomy, though both procedures are safe and improve quality of life.
RYGB was associated with greater 7-year weight loss than SG; leaves open optimal procedure selection pending randomized confirmation.
BACKGROUND/OBJECTIVES: There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. SUBJECTS/METHODS: Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril's ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. RESULTS: ) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5-7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. CONCLUSION: In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.
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Nielsen et al. (2022) conducted an observational in Severe obesity (n=543). Roux-en-Y gastric bypass vs. Sleeve gastrectomy was evaluated on Percent total weight-loss (%TWL) at 7 years (MD 3.9, 95% CI 2.0-5.7, p=0.001). Roux-en-Y gastric bypass resulted in a significantly greater 7-year percent total weight loss compared to sleeve gastrectomy (27.3% vs 23.4%, p=0.001), with similar improvements in quality of life.