Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies

Oct 11, 2016Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Long-term and midterm results of sleeve gastrectomy versus gastric bypass surgery

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Abstract

In a meta-analysis of 5264 patients, long-term weight loss outcomes favored laparoscopic Roux-en-Y gastric bypass (LRYGB) over laparoscopic sleeve gastrectomy (LSG).

No significant difference in midterm weight loss was observed between LRYGB and LSG.
Long-term weight loss after LRYGB was significantly greater than after LSG.
The follow-up period for the studies ranged from 36 months to approximately 75.8 months.
There was no significant difference in the resolution of type 2 diabetes, hypertension, hyperlipidemia, or hypertriglyceridemia between the two procedures.

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OBJECTIVE: This study aimed to compare midterm and long-term weight loss and resolution of co-morbidity with laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).

SUMMARY: LRYGB and LSG are the most common procedures performed in bariatric surgery. However, their weight loss efficacy in the midterm and long-term has not been well compared.

METHODS: A meta-analysis was performed by systematically identifying comparative studies conducted until the end of June 2016 that investigated weight loss outcome and resolution of co-morbidities (type 2 diabetes mellitus, hypertension, hyperlipidemia, hypertriglyceridemia, and obstructive sleep apnea) with LRYGB and LSG in the midterm (3-5 years) and long term (≥5 years). The primary endpoint was weight loss after LRYGB versus LSG. The secondary endpoint was resolution of co-morbidities after these procedures.

RESULTS: Fourteen studies comprising 5264 patients were eligible. Follow-up ranged from 36 months to 75.8±8.4 months. The pooled result for weight loss outcomes did not show any significant difference in midterm weight loss (standardized mean difference = -0.03; 95% confidence interval (CI), -0.38-.33; P = .88) but a significant difference in the long-term weight loss outcome favoring LRYGB (standardized mean difference = .17; 95% CI, .05-.28; P= .005). The pooled results demonstrated no significant difference for resolution of type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypertriglyceridemia.

CONCLUSION: Despite the insignificant difference between LRYGB and LSG in midterm weight loss, LRYGB produced better weight loss in the long-term. There was no significant difference between the 2 procedures for co-morbidity resolution.

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Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies

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