Sleeve gastrectomy versus Roux-en-Y-gastric bypass in patients with body mass index over 50 kg/m2: international multicentre cohortDepartment of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warszawa, Poland.
Department of General Surgery, School of Medicine, Marmara University, Istanbul, Turkey.
Health Sciences Faculty, Gedik University, İstanbul, Turkey.
Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.
Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.
Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital, Basel, Switzerland.
Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital, Basel, Switzerland.
Department of Visceral Surgery, Cantonal Hospital Baden, Baden, Switzerland.
Department of Visceral Surgery, Cantonal Hospital Glarus, Glarus, Switzerland.
Department of Gastroenterology and Hepatology, Cantonal Hospital Baselland, Liestal, Switzerland.
Department of Visceral Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
Department of Visceral Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
Department of Visceral Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Department of General-, Visceral-, Transplantation-, Vascular-, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Department of General-, Visceral-, Transplantation-, Vascular-, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Department of General-, Visceral-, Transplantation-, Vascular-, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Department of Visceral Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Department of Surgery, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
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2026 (English)In: BJS Open, E-ISSN 2474-9842, Vol. 10, no 2, article id zrag028Article in journal (Refereed) Published
Abstract [en]
Background: Patients with initial body mass index > 50 kg/m(2) are vastly under-represented in randomized clinical trials demonstrating similar weight loss and diabetes remission rates after sleeve gastrectomy and Roux-en-Y gastric bypass.
Methods: Propensity score matching 1 : 1 was used to compare outcomes regarding weight loss and diabetes control after sleeve gastrectomy and Roux-en-Y gastric bypass in patients with body mass index > 50 kg/m(2) between 2012 and 2022 in a cohort from 13 centres in six European countries. The primary endpoint was percentage total bodyweight loss; secondary endpoints were diabetes remission rate and rate of persistent body mass index > 40 kg/m(2).
Results: In total, 3976 of 8160 patients were matched and included in the analysis (1988 in each group). Median age at baseline was 40.0 (range 16-76) years in the sleeve gastrectomy group and 39.5 (15-71) years in the Roux-en-Y gastric bypass group. Median body mass index at baseline was 56.2 (range 50.0-100.0) and 54.3 (50.0-83.9) kg/m(2), respectively (P < 0.001). The follow-up rate was 70.5% at 1 year and 24.4% at 5 years. Percentage total bodyweight loss at 1 and 5 years after sleeve gastrectomy was 30.2 (2.2-63.7) and 25.4 (-4.8 to 56.0)%, respectively, versus 31.2 (7.4-54.5) and 28.2 (-6.6 to 62.9)% in the Roux-en-Y gastric bypass group (P < 0.001 between groups in both time points). The prevalence of persistent body mass index > 40 kg/m(2) after 1 and 5 years was 42.7 and 57.6%, respectively, after sleeve gastrectomy versus 24.5 and 39.2% after Roux-en-Y gastric bypass (P < 0.001 between groups in both time points). A 5-year follow-up, the prevalence of a pathological haemoglobin A1c level (> 6.5%) was 12.9% after sleeve gastrectomy and 11.6% after Roux-en-Y gastric bypass (P = 0.323).
Conclusion: This study suggests that Roux-en-Y gastric bypass results in greater weight loss than sleeve gastrectomy in patients with body mass index > 50 kg/m(2), whereas improvements in diabetes appear comparable between procedures.
Place, publisher, year, edition, pages
Oxford University Press, 2026. Vol. 10, no 2, article id zrag028
Keywords [en]
weight loss, diabetes remission, obesity class IV
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-128672DOI: 10.1093/bjsopen/zrag028ISI: 001753186300001PubMedID: 42053467OAI: oai:DiVA.org:oru-128672DiVA, id: diva2:2057639
2026-05-052026-05-052026-05-05Bibliographically approved