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LONG-TERM EFFECT OF SLEEVE GASTRECTOMY VS ROUX-EN-Y GASTRIC BYPASS IN PEOPLE LIVING WITH SEVERE OBESITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Mohammed Ayyad
*11, Islam Mohamad
1, Mohamed Abuelazm
2, Ahmed Mazen Amin
3, Abdallah Saeed
4, Mohamed Abouzid
5, Omar Al Ta'ani
6, AlMothana Manasrah
7, Mohammad Alqudah
8, Abdallah Bani-Salameh
9, Ubaid Khan
10, Hassan Ghoz
10, Mohammad Tanashat
81University of Missouri, Kansas, KS; 2Tanta University, Tanta, Egypt; 3Mansoura University, Mansoura, Egypt; 4Tanta University, Tanta, Egypt; 5Poznan University of Medical Sciences, Poznan, Poland; 6Allegheny Health Network, Pittsburgh, PA; 7UHS-Wilson Medical Center, Binghamton, NY; 8Yarmouk University, Irbid, Jordan; 9Jordan University of Science and Technology, Irbid, Jordan; 10University of Maryland, Baltimore, MD; 11Rutgers Health, Newark, NJ
Background: Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) are the most common bariatric procedures worldwide. This systematic review and meta-analysis evaluate their long-term efficacy and safety in individuals with severe obesity.
Methods: A systematic search of five electronic databases (PubMed, EMBASE, Scopus, Cochrane Library, and Web of Science) was performed for eligible studies published until February 17, 2024. Statistical analyses were conducted using R version 4.3.1. Outcomes were reported as Risk Ratios (RRs) or Mean Differences (MDs) with 95% Confidence Intervals (CIs). Statistical significance was set at P ? 0.05.
Results: Fourteen studies involving 2,290 patients were included. LRYGB was associated with significantly greater body weight change at three years (MD: 4.27; 95% CI [0.92, 7.61]; P = 0.01), five years (MD: 7.20; 95% CI [2.30, 12.10]; P < 0.01), and ? seven years (MD: 12.79; 95% CI [3.50, 22.07]; P < 0.01). Excess body weight loss was also higher with LRYGB at three years (MD: -13.27; 95% CI [-18.62, -7.92]; P < 0.01) and five years (MD: -17.66; 95% CI [-27.54, -7.78]; P < 0.01), with comparable results beyond seven years post-surgery.
Adverse event analysis showed LRYGB was associated with fewer early minor adverse events, while LSG reduced late major adverse events at five and seven years. There were no significant differences in early major or late minor adverse events. All-cause mortality and metabolic outcomes were similar between the two procedures.
Conclusion: LRYGB provides superior weight loss and BMI reduction over three, five, and seven years post-surgery compared to LSG. While LRYGB has fewer early minor adverse events, LSG reduces late major adverse events. Both procedures show similar long-term safety profiles regarding all-cause mortality and metabolic outcomes.
Keywords: Laparoscopic Sleeve Gastrectomy; Laparoscopic Roux-en-Y Gastric Bypass; Bariatric Surgery; Weight Loss; Meta-Analysis.
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