Roux-en-Y gastric bypass better than sleeve gastrectomy for weight loss: JAMA
Finland: Roux-en-Y gastric bypass (RYGB) results in greater weight loss than sleeve gastrectomy (SG) in obese patients, finds a recent study in the journal JAMA Surgery. However, improvement in quality of life (QoL) was similar in both the procedures.
Globally, the obesity epidemic is still increasing. Currently, bariatric surgery is the only effective treatment for morbid obesity that results in sustainable and substantial weight loss, improvement of QoL in the long term, and remission of obesity-related comorbidities. The 2 most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).
LSG is currently the predominant bariatric procedure, although long-term weight loss and QoL outcomes compared with laparoscopic Roux-en-Y gastric bypass are lacking. To fill this knowledge gap, Sofia Grönroos, Turku University Hospital, Turku, Finland, and colleagues performed the SLEEVE vs byPASS (SLEEVEPASS) trial to determine weight loss equivalence of LSG and LRYGB at 7 years in patients with morbid obesity, with special reference to long-term QoL.
SLEEVEPASS is multicenter, multisurgeon, open-label, randomized clinical equivalence trial that was conducted between March 10, 2008, and June 2, 2010, in Finland. The trial enrolled 240 patients (aged 18 to 60 years) with morbid obesity who were randomized to undergo either LSG (n=121) or LRYGB (n=119) with a 7-year follow-up.
The primary end point was percentage excess weight loss (%EWL) at 5 years.
Secondary predefined follow-up time points were 7, 10, 15, and 20 years, with included 7-year secondary end points of QoL and morbidity. Disease-specific QoL (DSQoL; Moorehead-Ardelt Quality of Life questionnaire [range of scores, –3 to 3 points, where a higher score indicates better QoL]) and general health-related QoL (HRQoL; 15D questionnaire [0-1 scale for all 15 dimensions, with 1 indicating full health and 0 indicating death]) were measured preoperatively and at 1, 3, 5, and 7 years postoperatively concurrently with weight loss.
Key findings of the study include:
- The mean %EWL was 47% after LSG and 55% after LRYGB.
- The mean (SD) DSQoL total score at 7 years was 0.50 after LSG and 0.49 after LRYGB, and the median HRQoL total score was 0.88 after LSG and 0.87 after LRYGB .
- Greater weight loss was associated with better DSQoL.
- At 7 years, mean (SD) DSQoL scores improved significantly compared with baseline (LSG, 0.50 vs 0.10; and LRYGB, 0.49 vs 0.12), unlike median HRQoL scores (LSG, 0.88 vs 0.87; and LRYGB, 0.87 vs 0.85).
- The overall morbidity rate was 24.0% (29 of 121) for LSG and 28.6% (34 of 119) for LRYGB.
"Our findings demonstrate that weight loss was not equivalent between LSG and LRYGB because somewhat greater weight loss was achieved after LRYGB; quality of life improvement was similar after both procedures," concluded the authors.
"Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss and Quality of Life at 7 Years in Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial," is published in the journal JAMA Surgery.
DOI: https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2020.5666
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