Friday, 14 Dec 2018

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Laparoscopic Gastric Sleeve Compared to Bypass Bariatric Surgery

JAMA reports the results of a 5 year Finnish study comparing the results of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass and shows that gastric bypass yielded greater weight loss at 5 years, the difference was not statistically significant, in patients with morbid obesity. 

The Sleeve vs Bypass (SLEEVEPASS) study included 240 adults with morbid obesity received open-label randomized intervention iwth either sleeve gastrectomy or gastric bypass with a 5-year follow-up period. The primary end point was weight loss evaluated by percentage excess weight loss. The pPrespecified equivalence margins were −9% to +9% excess weight loss.

The patients had a mean baseline BMI of 45.9, and 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension.  The results are shown in the table below:

 SleeveBypass
% Wt. Loss49%57%
DM remission37%45%
D/C Statins47%60%
D/C BP meds29%51%
Morbidity rate19%26%

 

 

 

 

 

 

 

 

While gastric bypass results were generally superior to gastric sleeve results, these were not significantly different. 

These results are similar to that seen in the STAMPEDE study showing similar (nonsignificant) but better results for bypass compared to gastric sleeve in the control of type II diabetes. (citation source: https://buff.ly/2rdYC3M

The five-year follow-up of this original study showed that:

  • 88% of gastric bypass and sleeve gastrectomy patients maintained healthy blood glucose levels without needinginsulin.
  • 29% of gastric bypass patients and 23% of sleeve gastrectomy patients achieved normal blood glucose levels
  • Weight loss was significantly greater with gastric bypass and sleeve gastrectomy compared than with medications 

The effects of both surgical procedures to normalize glucose levels did, however, diminish over time, and some late complications were noted with surgery.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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