Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Obesity and Diabetes Mellitus: Psychology and Quality of Life Outcomes at 10 Years - Report - MDSpire
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Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Obesity and Diabetes Mellitus: Psychology and Quality of Life Outcomes at 10 Years
10-Year Psychological and QOL Outcomes After Sleeve Gastrectomy vs Banded RYGB in Obese Diabetics
Overview
This randomized trial compared long-term psychological health and quality of life (QOL) outcomes in obese patients with type 2 diabetes mellitus (T2DM) undergoing sleeve gastrectomy (SG) versus silastic-ring Roux-en-Y gastric bypass (SR-RYGB). At 10 years postoperatively, both procedures showed improvements in depressive symptoms and QOL domains, with some differences in weight loss durability and psychological outcomes. Preoperative depression and anxiety influenced long-term weight loss outcomes.
Background
Metabolic bariatric surgery (MBS) improves obesity-related comorbidities and can enhance psychological health and quality of life (QOL). However, adverse effects and altered gastrointestinal function may negatively impact these patient-centered outcomes. Psychological screening is recommended preoperatively to optimize patient selection and outcomes. This study builds on prior 5-year data by evaluating 10-year psychological and QOL outcomes comparing SG and SR-RYGB in patients with obesity and T2DM in New Zealand, where public funding for MBS is limited.
Data Highlights
Measure
SG Group
SR-RYGB Group
Notes
Depressive Symptoms (HADS ≥8)
Significant improvement at 1 year; sustained at 5 and 10 years
Significant improvement at 1 year; sustained at 5 and 10 years
Both groups showed long-term reduction
Anxiety Symptoms (HADS ≥8)
Improved at 1 year; returned to baseline by 5 years
Improved at 1 year; returned to baseline by 5 years
No sustained long-term improvement
RAND-36 QOL Domains
Improvements noted in physical functioning, general health, emotional well-being
Similar improvements with some differences in magnitude
Patient-centered QOL improved postoperatively
Weight Loss Durability
Less durable weight loss over 10 years
Greater weight loss and limited weight regain
SR-RYGB with silastic ring showed better weight maintenance
Key Findings
Both SG and SR-RYGB significantly improved depressive symptoms at 10 years post-surgery.
Anxiety symptoms improved initially but returned to baseline levels by 5 years in both groups.
Quality of life, assessed by RAND-36, improved across multiple domains including physical functioning and emotional well-being in both surgical groups.
SR-RYGB with silastic ring demonstrated greater and more durable weight loss compared to SG.
Preoperative depression and anxiety symptoms influenced long-term weight loss outcomes, highlighting the importance of psychological assessment.
Clinical Implications
Long-term psychological and quality of life improvements support the use of both SG and SR-RYGB in obese patients with T2DM. The greater durability of weight loss with SR-RYGB may favor its selection in patients where sustained weight reduction is critical. Preoperative psychological screening remains essential to identify patients who may require additional support to optimize surgical outcomes.
Conclusion
This 10-year randomized trial demonstrates sustained improvements in depressive symptoms and quality of life after both SG and SR-RYGB, with SR-RYGB providing superior weight loss durability. Integrating psychological evaluation into preoperative assessment can enhance patient-centered care and long-term outcomes.
References
International Federation for Surgery of Obesity (IFSO) -- Psychological screening recommendations
RAND-36 Health Survey -- Quality of Life Assessment Tool
Previous 5-year outcomes from the same randomized trial
