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Meta-Analysis
. 2025 Mar;35(3):1146-1159.
doi: 10.1007/s11695-025-07743-6. Epub 2025 Feb 18.

Patients with Severe Obesity Undergoing Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy: A Systematic Review and an Updated Meta-Analysis

Pedro Bicudo Bregion  1 , André Milani Reis  1 , Rafaela Hamada Jucá  1 , Josélio Rodrigues de Oliveira-Filho  2 , Giulia Almiron da Rocha Soares  3 , Everton Cazzo  4 , Victor Kenzo Ivano  5
Affiliations
Meta-Analysis

Patients with Severe Obesity Undergoing Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy: A Systematic Review and an Updated Meta-Analysis

Pedro Bicudo Bregion et al. Obes Surg. 2025 Mar.

Abstract

Background: Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) contributes significantly to higher weight loss at 6 to 12 months when compared to Laparoscopic Sleeve Gastrectomy (LSG) in patients with severe obesity (SO-body mass index (BMI) ≥ 50 kg/m2). However, there is still no consensus regarding the best procedure in terms of mortality and complication rates. We performed a systematic review and meta-analysis to compare the complication rates between these two surgical procedures.

Methods: PubMed, EMBASE, and Cochrane Central were searched for studies that compared LRYGB and LSG in SO patients. We pooled outcomes for mortality and complications, defined as bleeding, cardiovascular events, conversion to open procedure, and a composite endpoint of leak, abscess, fistulas, and reoperation. Length of stay and operative time were also pooled. A random-effects model was used, and statistical analyses were performed using R version 4.4.0.

Results: A total of 156,767 patients from 28 observational studies were included, of whom 79,324 (50.6%) underwent LRYGB and 77,443 (49.4%) LSG. Length of stay (MD 0.45; 95% CI 0.42-0.48; P < 0.01) and operative time (MD 58.88; 95% CI 37.88-79.87; P < 0.01) were lower in the LSG group. Overall, there was no difference in mortality (OR 1.28; 95% CI 0.80-2.04; P = 0.311) and in complication rates (OR 1.22; 95% CI 0.85-1.76; P = 0.287). A subgroup analysis showed lower conversion to open procedure for patients who underwent LSG (OR 2.75; 95% CI 1.90-3.98; P < 0.001), and no difference was noted in bleeding (OR 0.98; 95% CI 0.47-2.07; P = 0.965), cardiovascular events (OR 0.99; 95% CI 0.43-2.29; P = 0.983), and a composite endpoint of leak, abscess, and fistulas (OR 0.82; 95% CI 0.67-1.01; P = 0.066).

Conclusion: Our meta-analysis suggests that there is no difference in mortality and complication rates between the two groups. However, length of stay and operative time were lower in SO patients who underwent LSG.

Keywords: Bariatric Surgery; Gastrectomy; Gastric Bypass; Obesity; Surgical Procedures, Operative.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests.

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