Gastric bypass vs sleeve gastrectomy in morbidly obese patients
Sleeve gastrectomy and bypass are overall very similar in terms of their effects on weight and comorbid conditions through 5 years.
No statistically significant difference in weight loss at 5 years was observed in comparing laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass in morbidly obese patients though both resulted in sustained weight loss, according to two studies published in JAMA.
Ralph Peterli, MD, from St. Claraspital in Basel, Switzerland, and colleagues conducted a randomized trial involving morbidly obese patients at four bariatric centers to determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. Participants were randomized to undergo laparoscopic sleeve gastrectomy (107 patients) or laparoscopic Roux-en-Y gastric bypass (110 patients).
Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3%. Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass.
In the second study, Paulina Salminen, MD, PhD, from Turku University Hospital in Finland, and colleagues enrolled 240 morbidly obese patients to examine the clinical equivalence of laparoscopic sleeve gastrectomy (121 patients) with laparoscopic Roux-en-Y gastric bypass (119 patients). The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010. The primary end point was weight loss evaluated by percentage excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life, all adverse events (overall morbidity), and mortality.
Among 240 patients randomized (mean age, 48 years; mean baseline BMI, 45.9; 69.6% women), 80.4% completed the 5-year follow-up. The estimated mean percentage excess weight loss at 5 years was 49% after sleeve gastrectomy and 57% after gastric bypass (difference, 8.2 percentage units, higher in the gastric bypass group) and did not meet criteria for equivalence. No statistically significant difference in quality of life between groups and no treatment-related mortality were observed. At 5 years, the overall morbidity rate was 19% (n = 23) for sleeve gastrectomy and 26% (n = 31) for gastric bypass.
In an accompanying editorial, authors David Arterburn, MD, MPH, and Anirban Gupta, MD, wrote, “These and other studies suggest that sleeve gastrectomy and bypass are overall quite similar in terms of their effects on weight and comorbid conditions through 5 years. Furthermore, the Israeli study supports and extends prior work in US and Swedish cohorts, indicating that these procedures may be associated with improved long-term survival compared with usual medical care. Overall, it seems that both procedures are excellent options for surgeons and patients to consider in the treatment of obesity.”
- Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3). doi:10.1001/jama.2017.20897
- Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3). doi:10.1001/jama.2017.20313
- Arterburn D, Gupta A. Comparing the outcomes of sleeve gastrectomy and roux-en-y gastric bypass for severe obesity. JAMA. 2018 Jan 16;319(3). doi: 10.1001/jama.2017.20449