No Clinical Significance in Weight Loss Among Sleeve Gastrectomy and Gastric Bypass Patients

There is little clinical significance when comparing weight loss among patients who underwent laparoscopic sleeve gastrectomy and patients who had Roux-en-Y gastric bypass surgery, according to studies published in JAMA as part of an obesity themed issue.

Patients who are morbidly obese often undergo bariatric surgery to lose weight and achieve a healthier lifestyle. Roux-en-Y gastric bypass was the original bariatric procedure until sleeve gastrectomy gained popularity, despite a lack of evidence proving the effectiveness of sleeve gastrectomy in the long run.

"The sleeve gastrectomy procedure is technically easier, faster to perform, and potentially safer compared with Roux-en-Y gastric bypass," explained the authors of one of the studies,¹ which was based in Switzerland. "However, much more data on clinical and metabolic long-term outcomes are available on the Roux-en-Y gastric bypass procedure."

Two studies—one carried out in Finland and the other in Switzerland—took a population of morbidly obese patients who were good candidates for both Roux-en-Y gastric bypass and sleeve gastrectomy. For the first study, the Finnish patient population was between 18 and 60 years, while the Swiss population in the second study was between 18 and 65 years. The populations were split randomly into 2 cohorts: 1 group was given sleeve gastrectomy while the other group underwent Roux-en-Y gastric bypass. After surgery, all patients had to undergo follow-ups to record weight loss. Both studies met with patients frequently during the first year after surgery and then annually after 2 years. These numbers were recorded over a 5-year period.

Patients who had Roux-en-Y gastric bypass lost slightly more weight than those who had sleeve gastrectomy in both studies; however, these numbers are not large enough to be clinically significant. In the Swiss study, excess body mass index loss was 61.1% for sleeve gastrectomy compared with 68.3% Roux-en-Y gastric bypass at 5 years. In the Finnish study, the estimated mean percentage excess weight loss was 49% after sleeve gastrectomy compared with 57% after Roux-en-Y gastric bypass at 5 years.

Quality of life among patients also increased after both bariatric procedures. The studies also looked at resolution of comorbidities. The number of patients suffering from type 2 diabetes, hypertension, dyslipidemia, sleep apnea, hyperuricemia, and joint pain was reduced overall. After 5 years, the overall morbidity rate was 19% in the first study and 14.9% in the second study for sleeve gastrectomy and 26% and 17.3% for gastric bypass, respectively.

“Among patients with morbid obesity, use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years,” concluded the authors of the Finnish.² “Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years, the difference was not statistically significant, based on the prespecified equivalence margins.”

References

1. Peterli R, Wölnerhanssen 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—265. doi:10.1001/jama.2017.20897.

2. Salminen P, Helmiö 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—254. doi:10.1001/jama.2017.20313