Surgical, metabolic, and prognostic outcomes for Roux-en-Y gastric bypass versus sleeve gastrectomy: a systematic review

Evander Meneses; Israel Zagales; Dino Fanfan; Ruth Zagales; Mark McKenney; Adel Elkbuli

doi:10.1016/j.soard.2021.06.020

Surgical, metabolic, and prognostic outcomes for Roux-en-Y gastric bypass versus sleeve gastrectomy: a systematic review

Surg Obes Relat Dis. 2021 Dec;17(12):2097-2106. doi: 10.1016/j.soard.2021.06.020. Epub 2021 Jul 7.

Authors

Evander Meneses¹, Israel Zagales¹, Dino Fanfan¹, Ruth Zagales¹, Mark McKenney², Adel Elkbuli³

Affiliations

¹ Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
² Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida.
³ Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida. Electronic address: Adel.Elkbulli@HCAHealthcare.com.

PMID: 34642101
DOI: 10.1016/j.soard.2021.06.020

Abstract

The purpose of this systematic review was to study 4 different aspects of Roux-en-Y gastric bypass (RYBG) and sleeve gastrectomy (SG). Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are two commonly performed bariatric procedures. This systematic review aims to compare RYGB with SG when it comes to weight changes, and cardiometabolic risk profile. Another aim was to evaluate laparoscopic and robotic techniques for both surgeries. PubMED, Cochrane Library, and JAMA Network were searched for articles evaluating RYGB and SG from 2005-2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Four different categories were analyzed comparing RYGB with SG as well as robotic versus laparoscopic approach. The Critical Appraisal Skills Program (CASP) checklist was used to assess the quality of evidence in the studies included in this systematic review. A total of 29 studies were included looking at different aspects of RYGB and SG. RYGB is superior to SG for weight loss, improved or complete remission of cholesterol and hypertensive medications. Consensus is lacking regarding decrease in BMI, total cholesterol, and triglycerides. There is lack of evidence regarding decrease of incidence of MI or stroke. For RYGB and SG, the majority of studies found that the robotic technique was more expensive and took longer. RYGB when compared with SG was associated with larger weight loss, decreased or cessation of cholesterol and hypertensive medications, and lower cholesterol. Decrease in BMI had varying results, with RYGB being superior in more studies, while there was no difference in other studies. There was a lack of evidence to support if RYGB or SG was superior to decreasing triglyceride levels. For both RYGB and SG, the robotic approach was costlier and took more operating time versus the laparoscopic approach.

Keywords: Body mass index; Metabolic disorders; Roux-en-Y gastric bypass; Sleeve gastrectomy; Weight loss surgery.

Publication types

Review
Systematic Review

MeSH terms

Gastrectomy / methods
Gastric Bypass* / methods
Humans
Obesity, Morbid* / surgery
Prognosis
Retrospective Studies
Treatment Outcome
Weight Loss