Skip to main content

Advertisement

SpringerLink
Log in

Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures.

Objectives

We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG.

Methods

Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years.

Results

Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002).

Conclusions

Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; (8):CD003641.

  3. Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149(12):1323–9.

    PubMed  PubMed Central  Google Scholar 

  4. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.

    PubMed  PubMed Central  Google Scholar 

  5. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    CAS  PubMed  Google Scholar 

  6. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    PubMed  Google Scholar 

  7. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    PubMed  Google Scholar 

  8. Vidal P, Ramon JM, Goday A, et al. Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results. Obes Surg. 2013;23(3):292–9.

    PubMed  Google Scholar 

  9. Lim DM, Taller J, Bertucci W, et al. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution. Surg Obes Relat Dis. 2014;10(2):269–76.

    PubMed  Google Scholar 

  10. Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case-control study and 3 years of follow-up. Surg Obes Relat Dis. 2012;8(3):243–9.

    PubMed  Google Scholar 

  11. Peterli R, Borbely Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013;258(5):690–4. discussion 695

    PubMed  Google Scholar 

  12. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.

    PubMed  Google Scholar 

  13. Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13(2):170–80.

    PubMed  Google Scholar 

  14. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.

    PubMed  Google Scholar 

  15. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    PubMed  Google Scholar 

  16. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    PubMed  Google Scholar 

  17. Chen Y, Corsino L, Shantavasinkul PC, et al. Gastric bypass surgery leads to long-term remission or improvement of type 2 diabetes and significant decrease of microvascular and macrovascular complications. Ann Surg. 2016;263(6):1138–42.

    PubMed  Google Scholar 

  18. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.

    PubMed  PubMed Central  Google Scholar 

  19. Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass on weight loss in patients with morbid obesity: The SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.

    PubMed  PubMed Central  Google Scholar 

  20. Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg. 2014;24(10):1617–24.

    PubMed  Google Scholar 

  21. Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: The SLEEVEPASS randomized clinical trial. JAMA. 2018;319(3):241–54.

    PubMed  PubMed Central  Google Scholar 

  22. Ignat M, Vix M, Imad I, et al. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg. 2017;104(3):248–56.

    CAS  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, et al. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.

    PubMed  Google Scholar 

  24. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    CAS  PubMed  Google Scholar 

  25. Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.

    PubMed  Google Scholar 

  26. Angrisani L, Santonicola A, Hasani A, et al. Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities. Surg Obes Relat Dis. 2016;12(5):960–8.

    PubMed  Google Scholar 

  27. Felsenreich DM, Langer FB, Prager G. Weight loss and resolution of comorbidities after sleeve gastrectomy: a review of long-term results. Scand J Surg. 2018;6:1457496918798192.

    Google Scholar 

  28. Noel P, Nedelcu M, Eddbali I, et al. What are the long-term results 8 years after sleeve gastrectomy? Surg Obes Relat Dis. 2017;13(7):1110–5.

    PubMed  Google Scholar 

  29. Osland E, Yunus RM, Khan S, et al. Postoperative early major and minor complications in laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures: a meta-analysis and systematic review. Obes Surg. 2016;26(10):2273–84.

    PubMed  Google Scholar 

  30. Young MT, Gebhart A, Phelan MJ, et al. Use and outcomes of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass: analysis of the American College of Surgeons NSQIP. J Am Coll Surg. 2015;220(5):880–5.

    PubMed  Google Scholar 

  31. Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(9):1655–62.

    PubMed  Google Scholar 

  32. Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–4.

    PubMed  Google Scholar 

  33. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    PubMed  Google Scholar 

  34. Miguel GP, Azevedo JL, de Souza PH, et al. Erosive esophagitis after bariatric surgery: banded vertical gastrectomy versus banded Roux-en-Y gastric bypass. Obes Surg. 2011;21(2):167–72.

    PubMed  Google Scholar 

  35. Ahmed B, King WC, Gourash W, et al. Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study. Surgery. 2018;164(4):774–83.

    PubMed  Google Scholar 

  36. Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-En-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26(5):926–32.

    PubMed  Google Scholar 

  37. Lager CJ, Esfandiari NH, Luo Y, et al. Metabolic parameters, weight loss, and comorbidities 4 years after Roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2018;28(11):3415–23.

    PubMed  PubMed Central  Google Scholar 

  38. Perrone F, Bianciardi E, Ippoliti S, et al. 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. Updat Surg. 2017;69(1):101–7.

    Google Scholar 

  39. Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25(1):19–26.

    PubMed  Google Scholar 

  40. Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016;26(2):429–42.

    PubMed  Google Scholar 

  41. Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(46):e8632.

    Google Scholar 

  42. Li JF, Lai DD, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg. 2013;56(6):E158–64.

    PubMed  PubMed Central  Google Scholar 

  43. Heffron SP, Parikh A, Volodarskiy A, et al. Changes in lipid profile of obese patients following contemporary bariatric surgery: a meta-analysis. Am J Med. 2016;129(9):952–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Spivak H, Sakran N, Dicker D, et al. Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis. Surg Obes Relat Dis. 2017;13(7):1189–94.

    PubMed  Google Scholar 

  45. Sheppard CE, Sadowski DC, de Gara CJ, et al. Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg. 2015;25(5):763–8.

    PubMed  Google Scholar 

  46. Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, Sleeve Dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27(12):3092–101.

    PubMed  Google Scholar 

  47. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.

    PubMed  Google Scholar 

  48. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    PubMed  Google Scholar 

  49. Mahawar KK, Jennings N, Balupuri S, et al. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship. Obes Surg. 2013;23(7):987–91.

    PubMed  Google Scholar 

  50. Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.

    PubMed  Google Scholar 

  51. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5.

    PubMed  Google Scholar 

  52. Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58.

    PubMed  Google Scholar 

  53. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    CAS  PubMed  Google Scholar 

  54. Marczuk P, Kubisa MJ, Swiech M, et al. Effectiveness and safety of Roux-en-Y gastric bypass in elderly patients-systematic review and meta-analysis. Obes Surg. 2019;29(2):361–8.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Hospitals of North Midlands, Sunderland, UK

    Alistair J. Sharples

  2. Sunderland Royal Hospital, Sunderland, UK

    Kamal Mahawar

Authors
  1. Alistair J. Sharples
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamal Mahawar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alistair J. Sharples.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Does not apply.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Table S1

(DOCX 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharples, A.J., Mahawar, K. Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. OBES SURG 30, 664–672 (2020). https://doi.org/10.1007/s11695-019-04235-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04235-2

Keywords

Search

Navigation