Beyond Five Years: A Matched Cohort of Sleeve Gastrectomy Versus Gastric Bypass

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 focuses on Roux-en-Y gastric bypass (LRYGB). This study compares weight loss in patients ≥5 years from LSG to matched patients who underwent LRYGB.

Objectives

The objective 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 BMI. Univariate and multivariate analysis was performed with weight loss at the longest duration the primary outcome.

Results

One-hundred sixty-five patients underwent LSG during the study period. Long-term follow-up data (≥5 years) was available for 85 patients (52%). There were no preoperative differences between those with and without follow-up data. 6 (7%) LSG patients were excluded as they underwent re-operation that altered intestinal anatomy. Of the 79 patients remaining, 75 were matched with post-LRYGB patients. The average follow-up period was 6.4y for LSG and 6.5y for LRYGB (p=0.08, NS). Change in BMI (ΔBMI) was 6.81 for LSG and 13.11 for LRYGB. Percent of total body weight loss (%TBWL) was 15.25% for LSG and 28.73% for LRYGB. Percent of excess body weight loss (%EBWL) was 37% for LSG vs 67% for LRYGB (p<0.0001). Weight loss for LSG follow-up in clinic vs outside clinic was 46% vs 34% (p=0.18, NS).

Conclusions

LSG is now the most common bariatric surgery in the US. Long-term data is 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 compared to matched LRYGB patients.