Comparison between Roux-en-Y Gastric Bypass to sleeve gastrectomy

1. While patients with Roux-en-Y Gastric Bypass had increased weight loss and higher type 2 diabetes remission compared to sleeve gastrectomy, the variability of effectivity was minimal across race and ethnicity. 

2. Racialized patients undergoing RYGB had increased risk of hospitalization, mortality, and major adverse events compared to SG. 

Evidence Rating Level: 2 (Good) 

While bariatric surgery continues to be very effective for managing severe obesity, various operations differ in long-term safety and effectiveness. As severe obesity is rapidly increasing in prevalence among racialized populations, more research into this area is essential. In this retrospective observational cohort study, 36871 adults and adolescents undergoing a Roux-en-Y Gastric Bypass (RYGB) or sleeve gastrectomy (SG) were included. The outcomes examined include percentage total weight loss, type 2 diabetes remission and relapse, as well as safety and utilization among various racialized groups. The results of this study showed that weight loss was more significant in the RYGB group than SG group (mean difference in percent total weight loss in Black patients was -7.6%, 95%CI -8.0 to -7.1). However, the magnitude of these differences was clinically small amongst different racialized groups. With respect to type 2 diabetes remission, only Hispanic patients were shown to have higher remission rates with RYGB compared to SG (HR 1.19, 95%CI 1.08-1.32). Black, Hispanic, and White patients had higher risk of operation and adverse events at year 5 with RYGB compared to SG (HR 1.45, 95%CI 1.17-1.79; HR 1.48, 95%CI 1.22-1.79; and HR 1.34, 95%CI 1.16-1.54, respectively). As well, risk of all-cause mortality was greater in Hispanic patients compared to other races (HR 2.41, 95%CI 1.24-4.70). In conclusion, this large multicenter cohort study shows that there was increased improvement in weight loss and type 2 diabetes remission in patients who underwent RYGB than SB surgery, with higher rates of adverse events observed in racialized populations. However, this study remains limited as it was not able to identify specific reasons why disparities among various racialized and ethnic groups. Additionally, in this study, more Hispanic and Black patients preferred SG compared to RYGB which may have potentially biased the results. Nevertheless, further research exploring factors involved in these racial differences with regards to outcomes after bariatric surgery can be very useful. 

Click to read the study in JAMA Surgery

Image: PD

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