Diabetes improvement and bariatric surgery—review of laparoscopic Roux-en-Y gastric bypass vs. laparoscopic vertical sleeve gastrectomy

Abstract

Obesity and type 2 diabetes mellitus (T2DM) are globally escalating major health care issues.For both obesity and T2DM management, it has been well established that bariatric surgery is superior to lifestyle and medical management alone. Over the past two decades, the introduction of laparoscopic vertical sleeve gastrectomy (LVSG) has seen a marked rise in usage, and combined with laparoscopic Roux-en-Y gastric bypass (LRYGB), these two procedures represent more than 80% of all bariatric surgeries globally.However, the differences in effectiveness between these two procedures have been less clearly defined. This article will serve as a focused review of the literature comparing LRYGB and LVSG for T2DM management.Based on our review, we believe that both procedures are very effective at improving T2DM care, especially compared with conventional medical management. However, there may be a modest benefit to be had by using LRYGB over LVSG.

Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy

“…The SLEEVEPASS trial enrolled 240 patients to undergo LVSG or RYGB. At six months, patients in the sleeve group when compared to patients in the bypass group had similar rates of excess weight loss (49.2% vs. 52.9%), resolution or improvement in diabetes (84.3% vs. 93.3%), hypertension (76.8% vs. 81.9%), and hypercholesterolemia (64.1% vs. 69.0%) (24,86). Regarding long term outcomes, the same SLEEVEPASS trial, five-year data of that trial reported mean excess weight loss of 49% in sleeve patients compared to 57% in bypass patients, a difference which was not statistically significant.…”

“…Regarding short term outcomes, an analysis of the NSQIP database analyzed 24,117 patients who underwent LVSG or bypass for morbid obesity. When compared with RYGB patients who had a LVSG had a shorter operative time (101 vs. 130 min), and lower rates of blood loss requiring transfusion (0.6% vs. 1.5%), deep wound infection (0.06% vs. 0.2%), serious morbidity rate (3.8% vs. 5.8%), and 30-day reoperation rate (1.6% vs. 2.5%) (24,84). An analysis of the 2015 MBSAQIP database of 134,142 patients demonstrated a lower mortality rate (0.1% vs. 0.2%), morbidity rate (5.8% vs. 11.7%), and leak rate (0.8% vs. 1.6%) in patients undergoing LVSG when compared to RYGB (24,85).…”

“…It reports that both procedures are very effective at improving T2DM care, especially compared with conventional medical management. However, there may be a modest benefit to be had by using LRYGB over LVSG (24). Finally, a claims-based cohort study conducted in 2021 favored the continued use of RYGB over VSG among bariatric candidates for whom diabetes medication discontinuation is of paramount importance.…”

“…The introduction of the laparoscopic vertical sleeve gastrectomy (LVSG) has seen a marked rise in usage, even overtaking Rouxen-Y Gastric Bypass (RYGB) (23,24); in fact, it has become the most popular operation for the treatment of morbid obesity in the United States and worldwide due to its technical simplicity and palatability to patients (25,26).…”

Laparoscopic Sleeve Gastrectomy: Outcomes, Safety and Complications

“…A body of literature compared the T2DM outcomes of LSG vs conventional medical management [13,14]. The 5 year outcomes from an RCT (STAMPEDE) that compared intensive medical therapy with BS (LSG or RYGB) found that among 134 individuals, diabetes remission was observed in 5% who received intensive medical therapy alone, compared with 23% who underwent LSG (P = 0.07) [14].…”