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. 2023 Jun;37(6):4351-4359.
doi: 10.1007/s00464-022-09785-8. Epub 2023 Feb 6.

Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass: a propensity score matched nationwide analysis

Erman O Akpinar  1   2 , Ronald S L Liem  3   4 , Simon W Nienhuijs  5 , Jan Willem M Greve  6   7   8 , Perla J Marang-van de Mheen  9 ; Dutch Audit for Treatment of Obesity Research Group
Collaborators, Affiliations

Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass: a propensity score matched nationwide analysis

Erman O Akpinar et al. Surg Endosc. 2023 Jun.

Abstract

Background: Literature remains scarce on patients experiencing weight recurrence after initial adequate weight loss following primary bariatric surgery. Therefore, this study compared the extent of weight recurrence between patients who received a Sleeve Gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) after adequate weight loss at 1-year follow-up.

Methods: All patients undergoing primary RYGB or SG between 2015 and 2018 were selected from the Dutch Audit for Treatment of Obesity. Inclusion criteria were achieving ≥ 20% total weight loss (TWL) at 1-year and having at least one subsequent follow-up visit. The primary outcome was ≥ 10% weight recurrence (WR) at the last recorded follow-up between 2 and 5 years, after ≥ 20% TWL at 1-year follow-up. Secondary outcomes included remission of comorbidities at last recorded follow-up. A propensity score matched logistic regression analysis was used to estimate the difference between RYGB and SG.

Results: A total of 19.762 patients were included, 14.982 RYGB and 4.780 SG patients. After matching 4.693 patients from each group, patients undergoing SG had a higher likelihood on WR up to 5-year follow-up compared with RYGB [OR 2.07, 95% CI (1.89-2.27), p < 0.01] and less often remission of type 2 diabetes [OR 0.69, 95% CI (0.56-0.86), p < 0.01], hypertension (HTN) [OR 0.75, 95% CI (0.65-0.87), p < 0.01], dyslipidemia [OR 0.44, 95% CI (0.36-0.54), p < 0.01], gastroesophageal reflux [OR 0.25 95% CI (0.18-0.34), p < 0.01], and obstructive sleep apnea syndrome (OSAS) [OR 0.66, 95% CI (0.54-0.8), p < 0.01]. In subgroup analyses, patients who experienced WR after SG but maintained ≥ 20%TWL from starting weight, more often achieved HTN (44.7% vs 29.4%), dyslipidemia (38.3% vs 19.3%), and OSAS (54% vs 20.3%) remission compared with patients not maintaining ≥ 20%TWL. No such differences in comorbidity remission were found within RYGB patients.

Conclusion: Patients undergoing SG are more likely to experience weight recurrence, and less likely to achieve comorbidity remission than patients undergoing RYGB.

Keywords: Bariatric surgery; Non-responder; Roux-en-Y gastric bypass; Sleeve gastrectomy; Total weight loss; Weight recurrence.

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Conflict of interest statement

Drs. Ronald Liem is educational consultant for Medtronic, gives medical expert training for Olympus, and is part of clinical immersion for bariatric surgery at the Johnson and Johnson Institute. Prof. Dr. Jan Willem Greve is on the Scientific Advisory Board of GI Dynamics and is on the speakers’ bureau of Bariatric Solutions, Drs. Erman Akpinar, Dr. Simon Nienhuijs, and Dr. Perla Marang-van de Mheen have no conflict of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of included patients DATO Dutch Audit for Treatment of Obesity, RYGB Roux-en-Y Gastric Bypass, SG Sleeve Gastrectomy and TWL Total Weight Loss
See this image and copyright information in PMC

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