Gastric Bypass Beats Sleeve Gastrectomy in the Long Run

TOPLINE:

Roux-en-Y gastric bypass (RYGB) led to greater excess body mass index (BMI) loss than sleeve gastrectomy in patients with severe obesity over 10 years, with the latter procedure being associated with higher conversion rates to different bariatric procedures and an increased risk for gastroesophageal reflux disease (GERD).

METHODOLOGY:

• Since 2014, sleeve gastrectomy has surpassed RYGB as the most frequently performed bariatric metabolic procedure globally; however, recent long-term studies indicate significant rates of recurrent weight gain, new-onset GERD, and need for reoperations after sleeve gastrectomy.
• Researchers from the Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) trial compared long-term weight and metabolic outcomes in patients with severe obesity randomized to either laparoscopic sleeve gastrectomy or RYGB at four bariatric centers.
• The primary outcome of this follow-up report on SM-BOSS was percentage excess BMI loss at 10 years and beyond; secondary outcomes included changes in weight, obesity-related diseases, reoperation rates, and quality of life at the same time range.

TAKEAWAY:

• Of 217 enrolled patients (mean BMI, 43.9; mean age, 42.5 years; 71.9% women), 107 underwent laparoscopic sleeve gastrectomy and 110 RYGB; 10-year follow-up was available for 65.4% of patients.
• Among patients who completed weight-related assessments 10 years after the surgery without undergoing any treatment changes prior to the assessments, RYBG led to greater excess BMI loss than sleeve gastrectomy (65.9% vs 56.1%; P = .048).
• Those who underwent sleeve gastrectomy vs RYBG had significantly higher conversion rates to different bariatric procedures (29.9% vs 5.5%; P < .001), primarily due to insufficient weight reduction or reflux.
• De novo GERD occurred in significantly more patients after sleeve gastrectomy than RYGB (32.3% vs 7.9%; P = .02).
• Both procedures resulted in similar improvements in obesity-related comorbidities, including type 2 diabetes remission (P = .71).

IN PRACTICE:

“RYGB led to significantly higher [percentage excess BMI loss] in the [per-protocol] population compared to SG [sleeve gastrectomy] beyond 10 years’ follow-up. Improvement of comorbidities was similar except for GERD, which seems to be better controlled by RYGB,” the authors wrote.

SOURCE:

The study was led by Marko Kraljević, MD, Clarunis, Department of Visceral Surgery, University Digestive Health Care Center, St. Clara Hospital and University Hospital, Basel, Switzerland. It was published online in JAMA Surgery.

LIMITATIONS:

The trial was initially designed and powered for a 5-year follow-up, potentially resulting in insufficient statistical power at 10 years due to participant loss. The high conversion rate from sleeve gastrectomy to RYGB in the study population may have influenced the interpretation of long-term outcomes. The study lacked sufficient power to distinguish outcomes related to type 2 diabetes remission.

DISCLOSURES:

The study was supported by grants from the Swiss National Science Foundation and Ethicon Endo Surgery USA. Some authors reported receiving grants, personal fees, or lecture fees from the funding sources or other pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.