Long-term quality of life after sleeve gastrectomy vs Roux-en-Y Gastric Bypass in patients with severe obesity: Results from the SleeveBypass multicentre randomised controlled trial

Abstract

Background: Limited information is available on long-term quality of life (QoL) outcomes after sleeve gastrectomy compared to Roux-en-Y gastric bypass.

Methods: These techniques were compared in an open-label randomised controlled trial. This paper focuses on generic health-related QoL (HRQoL) using the 36-Item Short Form Health Survey and EuroQol-5 Dimension 3-Level questionnaires and disease-specific QoL (DSQoL), using the Moorehead-Ardelt questionnaire (specifically designed for individuals with obesity to assesses self-esteem, physical activity, work performance, sexual life, eating behaviour, and social interactions)the Gastroesophageal Reflux Disease Questionnaire (GERD-Q); the Gastrointestinal Quality of Life Index (GIQLI); and the Asthma Control Questionnaire. Simple carbohydrate consumption was assessed with the Dutch Sweet Eating Questionnaire. Measurements were taken preoperatively, 2 months post-surgery, and annually up to 5 years. Analyses used a linear mixed model. Cohen's d (CD) effect sizes indicate small (0∙2), medium (0∙5), and large (0∙8) effects. Dutch Trial Register NTR4741.

Findings: From 2013 until 2017, 628 patients were randomised between sleeve gastrectomy (n = 312) and Roux-en-Y gastric bypass (n = 316). Minimal follow-up was 5 years (last follow-up July 29th, 2022). Mean age was 43 [SD, 11] years; mean BMI 43∙5 [SD, 4∙7] and 81∙8 % were women. No clinically relevant differences in generic HRQoL were observed. Moorehead-Ardelt scored higher in the bypass group at 2 years (difference 0∙4, [95 % CI -0∙6 to -0∙1], P=.002, CD -0∙3), without statistically differences later on. GERD-Q scores were consistently better in the bypass group at all time points and remained higher after 5 years (difference 1∙5, [95 % CI 0∙7 to 2∙3], P<.001, CD 0∙3). GIQLI showed a statistically significant better outcome in the bypass group after 4 and 5 years (difference -4∙6, [95 % CI -8∙7 to -0∙4], P = 0.032, CD -0∙17). Sweet-eating showed no statistically significant differences over time.

Conclusion: For patients living with severe obesity, sleeve gastrectomy and Roux-en-Y gastric bypass overall showed good long-term HRQoL and DSQoL outcomes. Roux-en-Y gastric bypass was associated with less GERD-related symptoms. Factors such as GERD should be considered when choosing the type of surgery.

Keywords: Bariatric surgery; Gastroesophageal reflux disease; Moorehead-Ardelt score; Quality of life; Roux-en-Y gastric bypass; Sleeve gastrectomy.