Both Roux-en-Y gastric bypass bests sleeve gastrectomy for weight reduction, reveals research

A new study published in the journal of The Lancet Diabetology and Endocrinology revealed that with 68% of individuals obtaining at least 50% excess weight reduction, Roux-en-Y gastric bypass was determined to be the most successful procedure for treating extreme obesity. This is in contrast to 41% for sleeve gastrectomy and 25% for adjustable gastric banding.

Bariatric and metabolic surgery can result in a 20% to 30% reduction in overall weight. According to trials, obesity-management pharmaceuticals can reduce overall weight loss by up to 24%. However, this may be less in real-world situations. The long-term effects and acceptability of these medications are unknown.

Both bariatric and metabolic surgery can lower the health risks associated with extreme obesity; however, it is unclear which procedure is more cost-effective or efficient. Thus, this study was set out to compare sleeve gastrectomy, adjustable gastric banding, and Roux-en-Y gastric bypass in individuals who were extremely obese.

A total of 12 UK hospitals participated in the pragmatic, multi-center, open-label, randomized controlled study known as By-Band-Sleeve. Adults (≥18 years old) who satisfied national requirements for bariatric and metabolic surgery were eligible participants. When sleeve gastrectomy became popular in the UK, two and a half years after the study's inception, a two-group experiment was expanded to a three-group trial.

Weight and quality-of-life (EQ-5D utility score) at 3 years were co-primary objectives. Sleeve gastrectomy and Roux-en-Y gastric bypass were deemed more effective than adjustable gastric banding and sleeve gastrectomy more effective than Roux-en-Y gastric bypass if the percentage of patients who achieved at least 50% excess weight loss was non-inferior and quality-of-life was superior. 

A total of 1,351 individuals were randomly allocated between January 16, 2013, and September 27,2019. 1,346 of them were included in this research, while 5 withdrew their permission.

There were 1,346 participants, of whom 462 (34%) underwent a Roux-en-Y gastric bypass, 464 (34%) underwent an adjustable gastric banding, and 420 (31%) underwent a sleeve gastrectomy. Surgery was performed on 1,183 (88%) of the subjects.

At least 50% excess weight reduction was attained by 276 (68%) of 405 patients in the Roux-en-Y gastric bypass group, 97 (25%) of 383 participants in the adjustable gastric banding group, and 141 (41%) of 342 people in the sleeve gastrectomy group.

Roux-en-Y gastric bypass, adjustable gastric banding, and sleeve gastrectomy all had mean EQ-5D ratings of 0·72, 0·62, and 0·68, respectively. After surgery, 1,651 adverse events were documented. Overall, it is suggested that patients who choose metabolic and bariatric surgery have Roux-en-Y gastric bypass.

Reference:

By-Band-Sleeve Collaborative Group. (2025). Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial. The Lancet. Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(25)00025-7