Weighing the impact of bariatric surgery: A meta-analysis of long-term outcomes of Roux-en-Y gastric bypass and sleeve gastrectomy.

Abstract

Obesity is the second-leading cause of preventable death in the United States and is known to be associated with serious health conditions, including cardiovascular disease, diabetes, and malignancy. The purpose of this meta-analysis was to aggregate the largest body of data on the long-term efficacy of Roux-en-Y gastric bypass and sleeve gastrectomy on weight reduction and comorbidity resolution in patients with obesity. A meta-analysis was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data on weight loss and prevalence diabetes and/or hypertension were aggregated per study protocol from those studies meeting inclusion criteria. Data were then analyzed and graphed with GraphPad Prism. Forty studies were included in this review, accounting for 51,055 patients. Baseline body mass index and prevalence rates of diabetes and hypertension were greatest in the surgical cohorts. Roux-en-Y gastric bypass was associated with maximal long-term body mass index reductions (-17.4 kg/m²) at 20-year follow-up, compared with (-11.0 kg/m²) at 10 years for sleeve gastrectomy. Both groups demonstrated a sustained decrease in the prevalence of diabetes at 10 years, 52.1% decrease for Roux-en-Y gastric bypass and 23.9% for sleeve. Although HTN data are less robust, Roux-en-Y gastric bypass maintains a 51.9% and 26.0% reduction in prevalence at 10 and 12 years, whereas sleeve gastrectomy returns to baseline prevalence of hypertension at 10 years. The medical and lifestyle management control group maintain baseline weight throughout the study period and demonstrate a consistent increase in diabetes and hypertension rates at all examined times. Sleeve gastrectomy and Roux-en-Y gastric bypass are effective in reducing weight and comorbidities beyond 10 years postoperatively, compared with minimal weight reduction and greater comorbidity prevalence in the control groups. Roux-en-Y gastric bypass produced more significant weight loss (1.4×) than sleeve gastrectomy, greater rates of diabetes reduction (2.0×), and sustained hypertension reduction, whereas this effect was lost for sleeve gastrectomy.