A NEW study offers valuable insights into the long-term effectiveness of three bariatric surgical procedures in patients with severe obesity (BMI≥35 kg/m2). The study compared these procedures in terms of weight loss, quality of life, metabolic health, and adverse events over a 3 year period. With increasing interest in bariatric surgery, the study aimed to clarify which procedures offer the best outcomes for patients. One key finding is that RYGB led to significantly greater weight loss and health improvements compared to the other two procedures.
The randomised controlled trial enrolled 1,159 participants, all of whom were adults with severe obesity referred for metabolic and bariatric surgery according to UK national criteria. Participants were randomly assigned to one of the three surgical groups: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). Data were collected on weight loss, quality of life (using the EQ-5D scale), comorbidities such as Type 2 diabetes, and adverse events during the 30-day post-surgery period and up to three years. The analysis incorporated both intention-to-treat and per-protocol approaches to ensure robustness, with sensitivity analyses to explore the impact of various factors.
The mean percentage weight loss for the RYGB group was –26.8% (–14.0% in the AGB group and –19.4% in the SG group). Quality of life improvements were significantly higher in the RYGB group (mean EQ–5D scores 0.72) compared to AGB (0.62), and SG (0.68). In terms of comorbidities, remission rates were greater in the RYGB group, compared to the AGB and SG groups for Type 2 diabetes (HbA1c <48 mmol/mol at 3 years was 91% in the RYGB group, 82% in the AGB group, and 88% in the SG group), hypertension, and dyslipidaemia. There were no significant differences in short-term adverse events, though fewer long-term adverse events were recorded in the SG group compared to RYGB and AGB.
In conclusion, this study provides strong evidence that Roux-en-Y gastric bypass is the most effective bariatric procedure for long-term weight loss and improvement in metabolic health. The study’s limitations include the potential for bias due to non-blinded surgical allocation and the challenges of recruitment over six years, which may have influenced data completeness. These findings should guide clinical practice, reinforcing the preference for RYGB in suitable patients while cautioning against the widespread use of adjustable gastric banding.
Reference
By-Band-Sleeve Collaborative Group. Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial. 2025;DOI: 10.1016/S2213-8587(25)00025-7.
