Gastric bypass leads to greater long-term excess BMI loss than sleeve gastrectomy
Key takeaways:
- Adults who underwent gastric bypass had more excess BMI loss 10 years after surgery than those who had a sleeve gastrectomy.
- More adults in the sleeve gastrectomy group required a conversion procedure.
Adults with obesity who underwent Roux-en-Y gastric bypass achieved a greater excess BMI loss at 10 years compared with those who underwent a laparoscopic sleeve gastrectomy, according to data published in JAMA Surgery.
“Sleeve gastrectomy and gastric bypass are both solid operations with good long-term results in terms of weight loss and remission of comorbidities, except for GERD that was better treated by gastric bypass,” Ralph Peterli, MD, professor of surgery at University of Basel in Switzerland, told Healio. “But the conversion rate (due to suboptimal clinical result or GERD) in the sleeve gastrectomy group was [higher] at 10 years’ follow-up compared [with] the gastric bypass group. In the per-protocol analysis only looking at patients that had the original operation type (excluding the conversions), sleeve gastrectomy was significantly inferior in terms of weight loss compared with gastric bypass.”
Peterli and colleagues assessed 10-year outcomes from the SM-BOSS randomized controlled trial, in which 217 adults aged 18 to 65 years with a BMI of at least 40 kg/m2 or at least 35 kg/m2 with at least one obesity-related comorbidity were randomly assigned to undergo gastric bypass or sleeve gastrectomy (mean age, 42.5 years; 71.9% women). Excess BMI loss at 10 years was the primary outcome of the study. The prevalence of obesity-related comorbidities and conversion procedures performed at 10 years were also collected.
Of the study group, 142 adults had data available at 10 years, including 69 who underwent sleeve gastrectomy and 73 who had gastric bypass performed. Both groups had reduced BMI at 10 years compared with baseline (P < .001 for both). In the per-protocol analysis including only patients who did not have a conversion, the gastric bypass group had a 65.9% excess BMI loss vs. a 56.1% excess BMI reduction for those who underwent sleeve gastrectomy (P = .048). Both groups had a similar percentage of adults achieving a 20% or greater weight loss at 10 years.
There was no significant difference between gastric bypass and sleeve gastrectomy in the proportion of adults who achieved remission of obesity-related diseases that were prevalent at baseline. Of adults who did not report GERD at baseline, 32.3% of the sleeve gastrectomy group developed reflux symptoms at 10 years compared with 7.9% of adults undergoing gastric bypass (P = .02).
Suboptimal response to surgery or GERD symptoms led to 29.9% of the sleeve gastrectomy group to undergo conversion surgery compared with 5.5% of the gastric bypass group (P < .001). Of those who underwent a conversion procedure in the sleeve gastrectomy group, 81.3% had gastric bypass performed.
Peterli said the difference in conversion rates between sleeve gastrectomy and gastric bypass stood out.
“After 10 years, there are still patients being converted,” Peterli said. “What can we expect 20 years or more after sleeve gastrectomy if this is the most often performed operation in the world and especially in young patients?”
The findings should spur researchers to identify predictors of outcomes for both sleeve gastrectomy and gastric bypass so health care professionals can determine which procedure is best for each patient, Peterli said.
For more information:
Ralph Peterli, MD, can be reached at ralph.peterli@clarunis.ch.
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