Evaluation of Bariatric Surgery Studies Helps Shed New Light on Long-Term Outcomes for Two Procedures

Brown, R. Evaluating the Effectiveness and Long-term Outcomes of Roux-en-Y Gastric Bypass vs Gastric Sleeve Bariatric Surgery in Obese and Diabetic Patients: Systematic Review. J Am Coll Surg. 2025; in press.

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), has emerged as highly effective interventions for weight loss and metabolic control; however, long-term comparative data on sustained weight loss, type 2 diabetes mellitus (T2DM) remission, and postoperative complications are inconsistent.

Using information from randomized controlled trials and observational cohort studies from 2005 to 2024, Rebekah Brown, from the St. James School of Medicine in Park Ridge, Illinois, prepared a systematic review of studies on adults that had at least 5 years of follow-up and assessed weight loss, T2DM remission, gastroesophageal reflux disease (GERD), Barrett esophagus, and anastomotic leak.

In aggregate, these studies showed that RYGB was associated with more significant long-term weight loss and superior T2DM remission rates and that SG had a lower risk of nutritional deficiencies with increased risk of complications requiring surgical revision, particularly GERD.

Brown acknowledges that the review has limitations due to variations in patient demographics, baseline body mass index, and comorbidities, but adds, “these outcomes are significant for patients researching weight loss options, as they represent a paradigm shift in T2DM management, from chronic medication dependence to potential disease resolution through bariatric surgery.”