10-Years Results of Sleeve Gastrectomy as Compared to Roux-en-Y Gastric Bypass in Patients with Morbid Obesity – A Case-Control Study

Elie K Chouillard, Ronald Daher, MD, Mariam Alahmadi, MD, Bashaer Alkandari, MD, Elias Chahine, Alain Fajardy, MD. PARIS POISSY MEDICAL CENTER

Introduction: Bariatric surgery is an effective therapy to induce long-term weight loss and control comorbidities in morbidly obese patients. We have been performing laparoscopic Roux-en-Y Gastric Bypass (RYGB) since 2001. Laparoscopic Sleeve Gastrectomy (SG), introduced in 2004 as a primary bariatric procedure, is currently the most commonly performed bariatric procedure in France. The aim of this study is to evaluate the 10-years results of SG for patients with morbid obesity as compared to RYGB in a case control study.

Methods and Procedures: We performed the first SG as a primary bariatric procedure in February 2004. After the accomplishment of the initial learning curve period, we started enrolling the patients in a prospective database. The aim of this study is to assess the long-term results of SG in patients who completed 10 years follow up. Subsequently, we performed a case control study by matching patients with those who had a RYGB during the same period.

Between December 2004 and August 2005, 26 patients had SG, of whom 4 were lost to follow up (15.4 %). During the same study period, 214 patients underwent RYGB of whom 22 were matched according to criteria including, age, sex, body mass index (BMI), and the type of comorbidities.

The primary endpoint was the 10-year percentage of excess weight loss (EWL). Secondary endpoints comprised resolution of comorbidities, reoperation for complications, revision, and quality of life (QOL) assessment.

Results: Average 10-years EWL was 48.8 % in the SG group and 61.8 % in the RYGB group (p<0.05). Three patients (13.6 %) in the SG group and 5 patients (22.7 %) in the RYGB were reoperated for complications (i.e., cholelithiasis, intestinal obstruction, perforated ulcer, stenosis) (p<0.05). In the SG group, 5 patients had revisions for reflux or insufficient weight loss (22.7 %). One patient who had RYGB had revision for weight loss insufficiency (4.5 %) (p<0.05). Resolution of comorbidities as well QOL assessment was comparable in both groups (p>0.05).

Conclusions: The analysis of the 10-years results in this small case control study shows that SG is associated to significantly less weight loss as compared to the RYGB. However, reoperation for complications is higher after RYGB.