Beyond 5 years: a matched cohort of sleeve gastrectomy versus gastric bypass

Katherine S Blevins; Luis Garcia; Joseph D Forrester; John M Morton; Dan E Azagury

doi:10.1016/j.soard.2022.03.008

Beyond 5 years: a matched cohort of sleeve gastrectomy versus gastric bypass

Surg Obes Relat Dis. 2022 Jun;18(6):789-793. doi: 10.1016/j.soard.2022.03.008. Epub 2022 Mar 18.

Authors

Katherine S Blevins¹, Luis Garcia¹, Joseph D Forrester¹, John M Morton¹, Dan E Azagury²

Affiliations

¹ Department of Surgery, Division of General Surgery, Stanford University School of Medicine, Stanford, California.
² Department of Surgery, Division of General Surgery, Stanford University School of Medicine, Stanford, California. Electronic address: dazagury@stanford.edu.

PMID: 35484048
DOI: 10.1016/j.soard.2022.03.008

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has demonstrated excellent short-term outcomes. However, existing studies suffer from loss to follow-up, and most long-term data focus on laparoscopic Roux-en-Y gastric bypass (LRYGB). This study compares weight loss in patients ≥5 years from LSG with that in matched patients who underwent LRYGB.

Objectives: The purpose of this study was to compare long-term weight loss in patients undergoing LRYGB and LSG.

Setting: University hospital, United States.

Methods: We retrospectively evaluated patients who underwent LSG before August 2012 with follow-up data ≥5 years. LSG patients were matched 1:1 with LRYGB patients by sex, age at surgery, and preoperative body mass index. Univariate and multivariate analyses were performed with weight loss at the longest duration the primary outcome.

Results: One-hundred and sixty-five patients underwent LSG during the study period. Long-term follow-up data (≥5 years) were available for 85 patients (52%). There were no preoperative differences between those with and without follow-up data. Six LSG patients (7%) were excluded because they underwent reoperation that altered intestinal anatomy. Of the 79 patients remaining, 75 were matched with post-LRYGB patients. The average follow-up period was 6.4 years for LSG patients and 6.5 years for LRYGB patients (P = .08, not significant). Change in body mass index was 6.81 kg/m² for LSG patients and 13.11 kg/m² for LRYGB patients. Percentage of total body weight loss was 15.25% for LSG patients and 28.73% for LRYGB patients. Percentage of excess body weight loss was 37% for LSG patients and 67% for LRYGB patients (P < .0001). Weight loss for LSG patient follow-up in clinic versus outside the clinic was 46% versus 34% (P = .18, not significant).

Conclusions: LSG is now the most common bariatric surgery in the United States. Long-term data are needed to confirm that observed short-term favorable outcomes are maintained. Recent studies have produced divergent results. We observed significantly less weight loss at ≥5 years in LSG patients compared with matched LRYGB patients.

Keywords: Gastric bypass; Long-term outcomes; Sleeve gastrectomy.

MeSH terms

Gastrectomy / methods
Gastric Bypass* / methods
Humans
Laparoscopy* / methods
Obesity, Morbid* / etiology
Obesity, Morbid* / surgery
Retrospective Studies
Treatment Outcome
Weight Loss