Clinical Report: Long-Term Outcomes of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass
Overview
This systematic review and meta-analysis evaluated 10-year outcomes comparing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in patients with morbid obesity. Results showed no statistically significant differences in total weight loss, excess weight loss, or diabetes remission between the two procedures over a decade.
Background
Bariatric and metabolic surgery is the most effective long-term treatment for severe obesity and its related comorbidities. Sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed bariatric procedures worldwide. Prior studies suggested RYGB may offer superior weight loss and metabolic control, but most lacked follow-up beyond five years. This meta-analysis synthesizes evidence from randomized controlled trials and observational studies with at least 10 years of follow-up to compare the durability and efficacy of these two procedures.
Data Highlights
Outcome
Mean Difference (SG vs RYGB)
95% Confidence Interval
P-value
Heterogeneity (I²)
Total Weight Loss (%TWL)
-1.78
-4.31 to 0.74
0.17
56%
Excess Weight Loss (%EWL)
-4.48
-9.57 to 0.60
0.08
41%
Total Weight Loss (%TWL) - pooled
-2.38
-3.85 to -0.92
0.001
56%
Excess Weight Loss (%EWL) - pooled
-4.92
-8.67 to -1.17
0.01
41%
Key Findings
No statistically significant difference in total weight loss (%TWL) between SG and RYGB at 10 years (mean difference -1.78; 95% CI -4.31 to 0.74; P=0.17).
No statistically significant difference in excess weight loss (%EWL) between SG and RYGB at 10 years (mean difference -4.48; 95% CI -9.57 to 0.60; P=0.08).
Pooled analyses showed a slight but statistically significant advantage for RYGB in %TWL (-2.38; 95% CI -3.85 to -0.92; P=0.001) and %EWL (-4.92; 95% CI -8.67 to -1.17; P=0.01) with moderate heterogeneity.
No significant difference in long-term diabetes remission rates between SG and RYGB at 10 years.
Moderate heterogeneity was observed in weight loss outcomes across included studies.
Clinical Implications
Both sleeve gastrectomy and Roux-en-Y gastric bypass provide durable weight loss and metabolic benefits at 10 years, with no clear superiority of one procedure over the other in long-term weight loss or diabetes remission. Clinicians can consider patient-specific factors and preferences when selecting the surgical approach, as both procedures demonstrate sustained efficacy over a decade.
Conclusion
This meta-analysis indicates that sleeve gastrectomy and Roux-en-Y gastric bypass yield comparable long-term outcomes in weight loss and diabetes remission at 10 years. These findings support the sustained effectiveness of both procedures for morbid obesity management.
References
Jimenez et al. 2019 -- Long-term outcomes of bariatric surgery
SleevePass 2022 -- Comparative study of SG and RYGB
SM-BOSS 2025 -- Randomized trial of bariatric procedures
