The purpose of a new study published in JAMA Surgery was to compare the long-term outcomes of laparoscopic sleeve gastrectomy (LSG) with laparoscopic Roux-en-Y-gastric bypass (LRYGB) in obese patients regarding weight loss and remission of obesity-related comorbidities and the consequential incidence of gastroesophageal reflux symptoms (GERD), endoscopic esophagitis, and Barrett esophagus (BE).

This was a 10-year observational study that evaluated patients in the Sleeve versus Bypass (SLEEVEPASS) multicenter randomized clinical trial design and compared LSG and LRYGB in the treatment of severe obesity. The study included 240 patients between 18-60 years of age, with a median BMI of 44.6. The study was conducted in Finland during 2008-2010 and the last follow-up occurred on January 27, 2021. The primary endpoint was a 5-year percentage excess weight loss (%EWL).

Over the 10 years––until the follow-up in 2021––two of the 240 randomized patients did not undergo surgery, while ten unrelated deaths were recorded. A total of 176 of the 228 remaining participants underwent gastroscopy. The median %EWL was 43.5% after LSG and 50.7% after LRYGB. While the mean estimate %EWL was not similar between the procedures – being 8.4% higher in LRYGB. On the other hand, there was no statistically significant difference between LSG and LRYGB in type 2 diabetes (T2D) remission, dyslipidemia, or obstructive sleep apnea (OSA). However, hypertension remission was superior after LRYGB and esophagitis were more prevalent after LSG. 

Of note, the reoperation rate was 15.7% for LSG and 18.5% for LRYGB.

It was inferred that the %EWL was greater after LRYGB and the procedures were not equivalent for weight loss on follow-up after 10 years. Both LSG and LRYGB rendered satisfactory and sustainable weight loss. Esophagitis was more prevalent after LSG, whereas the BE incidence was markedly lower than previously reported and comparable between the procedures.

Source: JAMA Surg. 2022 Jun 22. doi: 10.1001/jamasurg.2022.2229.