Surgery type did not significantly affect complication rates, but RYGB patients with BMI <40 achieved significantly higher total weight loss than those who underwent SG.
Does sleeve gastrectomy compared to Roux-en-Y gastric bypass affect total weight loss and complication rates in patients at extremes of age and BMI?
In patients at extremes of age and BMI, sleeve gastrectomy has similar complication rates to Roux-en-Y gastric bypass, though RYGB yields greater weight loss in patients with lower BMI.
Abstract Background Metabolic and bariatric surgery (MBS), such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), is an effective approach for treating obesity and its comorbidities. However, the outcomes of these surgeries in patients at extremes of age and BMI remain a topic of interest due to potential differences in complications and effectiveness. We aim to assess the type of MBS used and its complications, apart from the total weight loss (TWL) percentage outcomes, in extreme ages and BMIs. Methods We performed a retrospective cohort study assessing 2482 patients: 1737 who underwent RYGB, and 745 SG between 2019 and 2023. Patients were grouped by age (30, 30–60, 60 years old) and BMI (40, 40–50, 50 kg/m²) categories. Results Pre-and post-operative data, surgical complications, and TWL ≥ 20% at 6, 12, 18, and 24 months were evaluated. TWL ≥ 20% at all follow-up points was not significantly different in younger patients who underwent SG compared to RYGB. By contrast, SG patients with BMI 40 showed significantly lower adequate TWL compared to RYGB patients. Moreover, the rate of surgical complications across elderly patients and those with BMI 50 who were submitted to SG did not show significant differences compared to RYGB patients. In our clinical practice, although we perform significantly more RYGB surgeries overall, we often recommend SG for older patients for being a safer surgery with a lower risk of complications compared to RYGB, and for younger patients because it allows the possibility of future surgical options if needed (such as in cases of weight regain). For patients with lower BMI, SG could be sufficient for weight loss, although RYGB tends to result in greater long-term weight loss. Our results demonstrate that complication rates did not differ significantly across both surgical procedures. On the other hand, TWL outcomes were influenced by BMI showing that patients with lower BMI undergoing RYGB tended to achieve significantly higher total weight loss rates compared to SG. Furthermore, SG remains a safer option for super obese patients and, while it doesn't yield poor outcomes, these patients tend to experience less weight loss than those who are submitted to RYGB. Conclusion Thus, our clinical approach often leads to SG being used in patients at extreme age ranges and BMI values—but does our daily practice make sense? A personalized approach, considering patient-specific factors, is crucial to determine the most appropriate MBS, ensuring long-term success.
Faria-Teixeira et al. (2026) studied this question. Surgery type did not significantly affect complication rates, but RYGB patients with BMI <40 achieved significantly higher total weight loss than those who underwent SG.