A NEW study suggests that Roux-en-Y gastric bypass (RYGB) may offer superior long-term outcomes compared to sleeve gastrectomy (SG) for patients with severe obesity, particularly in terms of weight loss and managing gastroesophageal reflux disease (GERD). The findings come from the SM-BOSS (Swiss Multicenter Bypass or Sleeve Study) trial, which followed patients for more than 10 years.
The trial involved 217 patients who were randomly assigned to undergo either SG or RYGB between 2007 and 2011. The primary goal was to assess excess body mass index loss (%EBMIL) and other outcomes such as the rate of reoperations and quality of life. The results showed that patients who underwent RYGB achieved greater %EBMIL compared to those who had SG, particularly in the per-protocol analysis. At 10 years, RYGB patients had a mean %EBMIL of 65.9%, while SG patients had 56.1%. However, the overall percentage of total weight loss was similar between the two groups.
RYGB also proved to be more effective at managing GERD. Patients who underwent SG experienced significantly higher rates of de novo GERD compared to those who had RYGB (P = 0.02). Furthermore, a higher proportion of SG patients required conversion to different surgical anatomies due to insufficient weight loss or complications, compared to those in the RYGB group (29.9% vs. 5.5%).
Dr. Marko Kraljević, the study’s lead author, highlighted that while both procedures were effective in reducing weight and improving obesity-related conditions, RYGB showed a distinct advantage in long-term outcomes. “Our findings suggest that Roux-en-Y gastric bypass may offer better durability for weight loss and improved management of GERD in the long run,” he said.
The study did not find significant differences in quality of life or major complications between the two groups, indicating that both procedures remain viable options for managing severe obesity. However, the higher rate of anatomical conversion and GERD in the SG group might inform surgical decision-making.
Aleksandra Zurowska, EMJ
Reference
Kraljević M et al. Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity: The SM-BOSS Randomized Clinical Trial. JAMA Surg. 2025;DOI: 10.1001/jamasurg.2024.7052.
