Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years

Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most widely used bariatric procedures nowadays. The aim of this study was to compare long-term results on weight loss and comorbidities improvement for both procedures. A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 underwent LSG and 142 underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range 60-96). LSG showed greater effectiveness in percentage of excess weight loss (%EWL) at 180 days and at 1 year of follow-up. Instead, at 5th year follow-up LRYGB and LSG showed similar %EWL values (72.34 versus 70.26). LSG group showed a lack of weight loss in patients from 3 to 5 years after surgery, whereas LRYGB group patients maintained an effective weight loss during the entire follow-up period. In LSG group both length of stay and operative time were found to be shorter. LRYGB showed better effectiveness in type 2 diabetes mellitus (T2DM) resolution rate. None of the two techniques has proven to be clearly better than the other on a long-term follow-up analysis, except for the LRYGB better results in T2DM healing. According to our findings, in LSG Group after 3 years the weight remains stable.

A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

“…In this study, no statistical difference in midterm hypertension remission rates was found between the two groups, but long-term results showed that LRYGB had an obvious advantage. The results of these studies were similar to our results [2,10,15,20]. The exact mechanism of hypertension and a range of cardiovascular diseases due to obesity have not been confirmed.…”

“…The advantages of LRYGB were as follows: The shortterm results of LRYGB might be as effective as those of LSG, but medium-or long-term results could show a clear advantage. LRYGB could ensure a good quality of life and minimum side effects, effectively control metabolic complications including T2DM and hypertension [3,15], provide better blood glucose control, and lower blood lipid level effect [5].…”

“…Moreover, conclusions of studies that compared LRYGB with LSG in the remission of complications remained controversial. Some studies indicated that LRYGB was superior to LSG [5,15,16] in the remission of T2DM, while other studies suggested that the remission rates were similar in both groups [17]. Previous studies had shown an advantage for LRYGB in the remission of hypertension [18][19][20].…”

A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis

“…Our results showed that in the short term, LRYGB was superior to LSG in almost all aspects (except for sleep apnea because the sample size was not large enough). After including recent studies [29,31,34] of long-term follow-ups, the results showed that there were no differences between the two groups except for hypertension in the midterm and long term. Furthermore, over a longer time frame, the effect on comorbidities is equal to LSG despite better weight loss.…”

A Cohort Study on the Outcomes of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy Regarding the Change in Body Mass Index, Remission of Comorbidities and Quality of Life After 12-Month Follow-up

“…These findings are in general agreement with the conclusions of a meta-analysis of 32 studies involving 6526 patients conducted by Li et al [15], except that these authors describe a better resolution of SAH by LRYGB. In contrast, a study involving an Asian population [16] indicated that both interventions showed comparable efficiency in resolving DM2, DLP, arthralgia, OSAS and SAH, although LRYGB resulted in a more rapid resolution of DM2, a finding that has been supported by evidence presented in other studies [17,18].…”