Prospective comparative study between laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in the management of morbid obesity and its comorbidities

Abstract

Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Objective The aim of this study was to compare the results between LRYGB and LSG in the management of morbid obesity and its comorbidities. Methods Between January 2010 and January 2015, 434 morbid obese patients were randomized, operated upon, and followed up for 2 years in Al Ahli Hospital, Doha, Qatar. A total of 214 patients underwent LSG, and 220 patients underwent LRYGB. The mean BMI of all patients was 44 ± 10.8 kg/m 2 ; their mean age was 43 ± 4.9 years; and 72% of them were female. Patients were followed up at 3, 6, and 9 months and at 1 and 2 years. Operative time, length of hospital stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. Results Age, sex, BMI, and comorbidities were equal in both groups. The mean operative time for LSG was 86.9 ± 51.6 min and that for LRYGB was 108.4 ± 41.8 min. The conversion rate was 0.9% in both groups. Minor complications occurred more often in LRYGB than in LSG (17.2 vs. 8.4%). However, the difference in major complications did not reach statistical significance (4.5% for LRYGB vs. 1.4% for LSG). One-year excessive BMI loss was similar between the two groups (71.8 ± 21.9% for LSG and 77.2 ± 21.3% for LRYGB). The comorbidities were significantly improved after both procedures, except for gastroesophageal reflux disease, which showed a higher resolution rate after LRYGB. Conclusion Two years after surgery, both procedures were almost equally efficient regarding weight loss and improvement of comorbidities, except gastroesophageal reflux disease. LSG was associated with shorter operation time and fewer complications compared with LRYGB. Long-term follow-up data are needed to confirm these results.