Sleeve Gastrectomy With Jejunojejunal Bypass Versus Sleeve Gastrectomy: 12‐Month Outcomes From a Propensity Score–Matched Analysis

Sleeve gastrectomy is widely used to treat obesity, but inadequate weight loss or weight regain remains a clinical concern. Comparative evidence for sleeve gastrectomy with jejunojejunal bypass (SG‐JJB) versus standard sleeve gastrectomy (SG) is limited. This single‐centre retrospective cohort compared 12‐month outcomes and examined bypass proportion in relation to weight loss. Among 191 propensity score‐matched patients (126 SG; 65 SG‐JJB), matching‐weighted mean percentage total weight loss (%TWL) was 26.59% after SG and 30.16% after SG‐JJB. The adjusted difference was 3.55 percentage points (95% CI, 0.36 to 6.74; p = 0.030). After multiplicity adjustment, no clear between‐group differences were identified in glycemic, lipid, hepatic, or nutritional outcomes. Recorded complications and complaints were infrequent, limiting comparative safety inference. Among all 70 SG‐JJB patients, restricted cubic spline analysis suggested a non‐linear association between bypass proportion and %TWL (P for non‐linearity = 0.044). The fitted curve peaked at a bypass proportion of 0.359, with predicted %TWL of 35.62% (pointwise 95% CI, 32.86% to 38.39%). This peak was within the observed 10th‐to‐90th percentile interval of 0.272 to 0.371, although bootstrap analyses indicated uncertainty in its location. In this matched cohort, SG‐JJB was associated with greater 12‐month weight loss than SG. Evidence for differences in metabolic, nutritional and safety‐related outcomes remained inconclusive. The central observed bypass‐proportion interval may inform prospective evaluation but not current operative selection.