Early results favor laparoscopic sleeve gastrectomy over gastric bypass

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1. Laparoscopic sleeve gastrectomy (LSG) is a shorter procedure on average compared to laparoscopic roux-en-Y gastric bypass (LRYGB) and may exhibit a lower complication rate. 

2. At 1 year follow-up, the two operations were similarly effective with respect to weight loss, recovery from comorbidities and quality of life, but GERD remission and new-onset was more common after LSG. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Authors present a 1-year interim analysis of a multicenter Swiss RCT comparing LSG with LRYGB. They report shorter operating time with LSG and an almost-significant reduction in the 30-day complication rate (p=0.067), a trend that is consistent with prior studies. This trial was well-designed with four participating bariatric centers and 100% 1-year follow-up rate. About half of study participants completed 2-year follow-up and only 70 out of 217 patients returned for 3-year follow-up at the time point of analysis. Therefore some preliminary conclusions drawn in the study may be premature. Additionally, one of the main conclusions regarding complication rates has not yet reached statistical significance.

Click to read the study in Annals of Surgery

Relevant Reading: Bariatric Surgery: A Systematic Review and Meta-analysis

In-Depth [randomized control trial]: This study randomized 217 bariatric surgery patients across four medical centers to either laparoscopic sleeve gastrectomy (LSG) or laparoscopic roux-en-Y gastric bypass (LRYGB). The results presented here are from an interim analysis at 1 year with excess BMI loss as the primary endpoint. Patients were assessed four times within the first year and will be followed yearly thereafter. Other items assessed were eating behavior, comorbidities, anthropometric parameters, clinical parameters and quality of life. Prior to surgery, patients’ BMI ranged between 35 and 61, and the two groups were similar in terms of demographic characteristics, eating behavior and comorbidities. LRYGB operations lasted longer than LSG by a mean of about 21 minutes (p=0.003). In the LSG group 34% of patients underwent additional procedures such as cholecystectomies, compared to 24% in the LRYGB group, although this was not a significant difference (p=0.09). The difference in 30-day complication rates were also not significant between the two groups (8.4% LSG vs. 17.2% LRYGB p=0.067) and the difference in major complication rates was not significant. Weight loss and excessive BMI loss were similarly not significantly different between LSG and LRYGB. Comorbidity remission and improvement were also similar in the two groups, however patients who underwent sleeve gastrectomy were at a higher risk of new-onset GERD (12.5% vs. 4%, p=0.12) as well as returning GERD (75% vs. 50% p=0.008).

By Asya Ofshteyn and Allen Ho

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