Bariatric Surgery: Comparative Efficacy and Safety of SG and RYGB

Laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) are widely used bariatric procedures. More data on these procedures' comparative efficacy and safety needs to be available.

An Original Investigation on Surgery published in JAMA Network Open has concluded that perioperative risk should not be the deciding factor for choosing between sleeve gastrectomy and Roux-en-Y gastric bypass for primary bariatric surgery among adults with obesity, as both procedures have comparable and low perioperative risks.

The Bypass Equipoise Sleeve Trial was a registry-based, multicenter randomized clinical trial that analyzed baseline and perioperative data for patients undergoing bariatric surgery. The perioperative complications were analyzed, including all adverse events and serious adverse events (Clavien-Dindo grade >IIIb), as well as 90-day mortality.

Key Results from the Study

• The study included 454 men and 1282 women of mean age 43 years with BMI 35-50 undergoing primary bariatric surgery.
• The study was carried out at 23 hospitals in Sweden and Norway.
• A total of 1722 participants were analyzed. 878 underwent SG and 857 underwent RYGB.
• The mean (SD) operating time was shorter in those undergoing SG vs RYGB (47 vs 68 minutes).
• The median postoperative hospital stay was one day in both groups.
• The 30-day readmission rate after SG and RYGB was 3.1% and 4.0%, respectively.
• There was no 90-day mortality.
• The 30-day incidence of any adverse event in the SG and RYGB groups was 40 and 54, respectively.

Among obese adults in Sweden and Norway, a large clinical trial showed low perioperative morbidity for both SG and RYGB, with no significant difference between the two. Therefore, they said, the perioperative risk should not be the main concern when choosing between these procedures.

Reference

Hedberg S et al. Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(1):e2353141. doi:10.1001/jamanetworkopen.2023.53141