Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: A pilot study

BackgroundNutritional deficiencies are highly prevalent in obese patients. Bariatric surgery has been associated with adverse effects on homeostasis of significant vitamins and micronutrients, mainly after gastric bypass. The aim of the present study was to compare the extent of long-term postsurgical nutritional deficiencies between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).MethodsThis cross-sectional, pilot study included 95 patients who underwent RYGB or SG surgery with a mean follow-up of 4 years. Demographic, anthropometric, and biochemical parameters were compared according to the type of surgery.ResultsBoth types of surgery were associated with significant nutritional deficiencies. Vitamin B12 deficiency was significantly higher in patients with RYGB compared with SG (42.1% versus 5%, P = .003). The type of surgery was associated neither with anemia nor with iron or folate deficiency (SG versus RYGB: anemia, 54.2% versus 64.3%, P = .418; folate deficiency, 20% versus 18.4%, P = .884; iron deficiency, 30% versus 36.4%, P = .635).ConclusionDuring a mean follow up period of 4 years postRYGB or SG, patients were identified with several micronutrient deficiencies, including vitamin D, folate, and vitamin B12. SG may have a more favorable effect on the metabolism of vitamin B12 compared with RYGB, being associated with less malabsorption. Adherence to supplemental iron and vitamin intake is of primary significance in all cases of bariatric surgery.     

Resolution of metabolic syndrome and related metabolic disorders after bariatric surgery: comparison of sleeve gastrectomy and gastric bypass

Background

The effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on metabolic syndrome (MS) in morbidly obese patients have not been well studied.

Cardiac fat pat change after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis

Cardiac fat pad is a metabolically active organ that plays a role in energy homeostasis and cardiovascular diseases and generates inflammatory cytokines. Many studies have shown remarkable associations between cardiac fat thickness and cardiovascular diseases, making it a valuable target for interventions. Our meta-analysis aimed to investigate the effects of the 2 most popular bariatric surgeries (sleeve gastrectomy [SG] and Roux-en-Y gastric bypass [RYGB]) in cardiac fat pad reduction. A systematic review of the literature was done by searching in Scopus, Web of Science, Cochrane, and PubMed for articles published by September 16, 2022. This review followed the meta-analysis rules based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the inclusion criteria out of 128 potentially useful studies, including a total number of 822 patients. The results of subgroup analysis on the type of surgery showed that bariatric surgeries decreased the mean fat pad diameter, but the reduction was greater in SG than in RYGB. Epicardial and pericardial fat type showed a significant decrease of fat pad diameter. The results of subgroup analysis indicated RYGB had a significant reduction in mean fat pad volume. Computed tomography scan and cardiac magnetic resonance imaging showed a significant reduction of the mean cardiac fat pad volume. Epicardial and paracardial fat type showed a significant decrease in volume. The cardiac fat pad diameter and volume were significantly reduced after bariatric surgeries. SG showed greater reduction in fat pad diameter in comparison with RYGB, and RYGB had a significant reduction in mean fat pad volume.     

Impact of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy on gut microbiota: a metagenomic comparative analysis

BackgroundBariatric surgery is an effective therapeutic procedure for morbidly obese patients. The 2 most common interventions are sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).ObjectivesThe aim of this study was to compare microbiome long-term microbiome after SG and LRYGB surgery in obese patients.SettingUniversity Hospital, France; University Hospital, United States; and University Hospital, Switzerland.MethodsEighty-nine and 108 patients who underwent SG and LRYGB, respectively, were recruited. Stools were collected before and 6 months after surgery. Microbial DNA was analyzed with shotgun metagenomic sequencing (SOLiD 5500 xl Wildfire). MSPminer, a novel innovative tool to characterize new in silico biological entities, was used to identify 715 Metagenomic Species Pan-genome. One hundred forty-eight functional modules were analyzed using GOmixer and KEGG database.ResultsBoth interventions resulted in a similar increase of Shannon’s diversity index and gene richness of gut microbiota, in parallel with weight loss, but the changes of microbial composition were different. LRYGB led to higher relative abundance of aero-tolerant bacteria, such as Escherichia coli and buccal species, such as Streptococcus and Veillonella spp. In contrast, anaerobes, such as Clostridium, were more abundant after SG, suggesting better conservation of anaerobic conditions in the gut. Enrichment of Akkermansia muciniphila was also observed after both surgeries. Function-level changes included higher potential for bacterial use of supplements, such as vitamin B12, B1, and iron upon LRYGB.ConclusionMicrobiota changes after bariatric surgery depend on the nature of the intervention. LRYGB induces greater taxonomic and functional changes in gut microbiota than SG. Possible long-term health consequences of these alterations remain to be established.     

Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy

IntroductionLaparoscopic Roux-en-Y gastric bypass (LRYGB) is known to increase risk for calcium oxalate nephrolithiasis due to hyperoxaluria; however, nephrolithiasis rates after laparoscopic sleeve gastrectomy (LSG) are not well described. Our objective was to determine the rate of nephrolithiasis after LRYGB versus LSG.MethodsThe electronic medical records of patients who underwent LRYGB or LSG between 2001 and 2017 were retrospectively reviewed.Results1,802 patients were included. Postoperative nephrolithiasis was observed in 133 (7.4%) patients, overall, and 8.12% of LRYGB (122/1503) vs. 3.68% of LSG (11/299) patients (P < 0.001). Mean time to stone formation was 2.97 ± 2.96 years. Patients with a history of UTI (OR = 2.12, 95%CI 1.41–3.18; P < 0.001) or nephrolithiasis (OR = 8.81, 95%CI 4.93–15.72; P < 0.001) were more likely to have postoperative nephrolithiasis.ConclusionThe overall incidence of symptomatic nephrolithiasis after bariatric surgery was 7.4%. Patients who underwent LRYGB had a higher incidence of nephrolithiasis versus LSG. Patients with a history of stones had the highest risk of postoperative nephrolithiasis.     

Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass: a meta-analysis

BackgroundBariatric surgery could increase the risk of cholelithiasis, although it is unclear whether the incidence rates of cholelithiasis are similar after different bariatric procedures.ObjectivesTo compare the incidence rates of cholelithiasis after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in people with obesity.SettingMeta-analysis of cohort studies.MethodsWe searched the PubMed and Web of Science databases for relevant studies before December 2020, and estimated the summary odds ratios (OR) and 95% confidence intervals (CI) using a random-effects model or fixed-effects model, according to the heterogeneity.ResultsIn total, 8 cohort studies were included in this meta-analysis, and 94,855 and 106,844 participants received SG and RYGB, respectively. Compared with those receiving RYGB, the summary results showed that participants receiving SG had a 35% lower rate of cholelithiasis (OR, .65; 95% CI, .49–.86). Also, the participants receiving SG had a significantly lower incidence of cholecystectomy than those receiving RYGB (OR, .54; 95% CI, .30–.99). In a subgroup analysis, SG was associated with a significantly lower incidence of subsequent cholelithiasis than RYGB in both Western and non-Western countries. SG led to a significantly lower incidence of cholelithiasis than RYGB only when the follow-up was <2 years instead of over 2 years.ConclusionParticipants receiving SG had a significantly lower incidence of cholelithiasis than those receiving RYGB, particularly within the first 2 years after the bariatric surgery.     

Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network

BackgroundRoux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed bariatric procedures. Multiple studies have investigated the metabolic bone complications after bariatric surgery, but there is a paucity of data comparing bone health after RYGB and SG.ObjectivesTo compare the rates of major fractures and osteoporosis after Roux-en-Y gastric bypass and sleeve gastrectomy.SettingData from TriNetX multi-institutional research network that includes data from multiple health care organizations in the USA was analyzed at West Virginia University.MethodsWe conducted a retrospective cohort study using TriNetX, a federated multi-institutional research network. We identified patients who underwent RYGB or SG. Primary outcome was the rate of major fractures at 3 years after the procedure. Other outcomes included the rate of spine fracture, femur fracture, osteoporosis, and vitamin D deficiency at follow-up.ResultsIn unmatched analysis, patients with SG were less likely to have major fractures or an osteoporosis diagnosis than RYGB patients at 3 years after the procedure (P < .05). After propensity-score matching, similar results were noted; patients with SG were less likely to have major fractures than RYGB patients at 3 years after procedure (2.85% versus 3.66%, risk ratio [RR]: .78, 95% confidence interval [CI]: .71–.85), and a lower rate of osteoporosis diagnosis was noted in the SG group. High rates of vitamin D deficiency were noted in both cohorts. The incidence of spine fractures was significantly lower in the SG group than in the RYGB group (.76% versus 1.18%, RR: .65, 95% CI: .54–.77). Similarly, the incidence of femur fracture was significantly lower after SG (RR: .62, 95% CI: .44–.88). Female sex, higher age, smoking history, and diabetes were independently associated with osteoporosis diagnosis during follow-up (all P values <.05).ConclusionOur analyses showed that RYGB is associated with a higher risk of osteoporosis, vitamin D deficiency, and osteoporotic fractures. Thus, in patients with a higher baseline osteoporotic risk, SG may be preferred option; however, further studies are needed.     

Early postoperative complications after gastric bypass revisional surgery in patients with previous sleeve gastrectomy versus primary gastric bypass

BackgroundRevisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity.ObjectiveTo evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center.SettingDepartment of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain.MethodsRetrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed.ResultsSix hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P = .017). Mean initial body mass index was 44.2 kg/m² (RYGB-RS) versus 47.6 kg/m² (RYGB-1; P = .004). Cardiovascular risk factors were higher in the RYGB-1 group (P < .05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien–Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P > .05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%).ConclusionNo differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands.     

袖状胃切除术与胃旁路术治疗GK大鼠疗效的比较研究

目的:对比袖状胃切除术与胃旁路术治疗大鼠非肥胖2型糖尿病的疗效。方法:30只GK大鼠随机分为袖状胃切除术组(SG组)、胃旁路术组(RYGB组)、假手术组(SO组),每组10只。观察术后各组存活情况,并根据情况检测各组术前及术后第1、4、8周的体质量、空腹血糖、口服糖耐量试验峰值、糖化血红蛋白比值及血清胰岛素水平。结果:SG组大鼠手术存活率100%,RYGB组手术存活率90%,SO组大鼠全部健康存活,3组手术存活率比较差异无统计学意义(P=0.305)。术后8周时,各组体质量均超过术前,RYGB组明显低于SO组和SG组(P0.05)。空腹血糖在SG组和RYGB组术后第1周即有下降趋势,术后8周时SG组较SO组降低,差异有统计学意义(P0.05),RYGB组较SO组明显降低(P0.01),RYGB组与SG组比较差异亦有统计学意义(P0.05)。口服糖耐量试验峰值在SG组和RYGB组术后1周即有下降,术后8周时SG组较SO组虽有降低但差异无统计学意义(P0.05),RYGB组较SO组明显降低(P0.01)。术前各组糖化血红蛋白比值差异无统计学意义,术后8周时SG组较SO组降低(P0.05),RYGB组较SO组明显降低(P0.01),RYGB组与SG组差异亦有统计学意义(P0.05)。8周后胰岛素水平SO组与SG组比较差异无统计学意义(P0.05),RYGB组在8周后升高明显,与前2组比较差异具有统计学意义(P0.05)。结论:袖状胃切除术与胃旁路术术后存活率相近,但胃旁路术治疗GK大鼠的疗效优于袖状胃切除术。     

Systematic review on sleeve gastrectomy or Roux-en-Y gastric bypass surgery for refractory gastroparesis

Management of refractory gastroparesis is challenging after diet, prokinetics, and long-term nutritional support have failed. In this review, the efficacy and safety of surgical interventions (sleeve gastrectomy and Roux-en-Y gastric bypass surgery) are evaluated systematically in patients with refractory gastroparesis. The PubMed, Embase, and Scopus databases were searched to identify relevant studies published up to June 2021. Outcome of interest was symptom improvement and gastric emptying. Nineteen studies with 222 refractory gastroparesis patients (147 Roux-en-Y gastric bypass, 39 sleeve gastrectomy, and 36 subtotal gastrectomy) were included. All studies reported symptom improvement postoperatively, particularly vomiting and nausea. Gastric emptying improved postoperatively in 45% up to 67% for sleeve gastrectomy and 87% for Roux-en-Y gastric bypass. The findings of our systematic review suggest that sleeve gastrectomy and Roux-en-Y gastric bypass surgery improve symptoms and gastric emptying in patients with refractory gastroparesis. Surgery may be effective as treatment for a small group of patients when all other therapies have failed.     

Anemia,iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis

BackgroundThe effective treatment of postoperative anemia and nutritional deficiencies is critical for the successful management of bariatric patients. However, the evidence for nutritional risk or support of bariatric patients remains scarce. The aims of this study were to assess current evidence of the association between 2 methods of bariatric surgery, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), and postoperative anemia and nutritional deficiencies.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for English-language studies using a list of keywords. Reference lists from relevant review articles were also searched. In the authors’ meta-analysis, they included studies with a duration of>12 months, those comparing SG with RYGB, and those with available outcome data for postoperative anemia and iron and vitamin B₁₂ deficiencies. Of 36 potentially relevant studies, 9 met the inclusion criteria. Data were combined by means of a fixed-effects model or random-effects model.ResultsCompared with the SG group, the odds ratio for postoperative vitamin B₁₂ deficiency in the RYGB group was 3.55 (95% confidence interval, 1.26–10.01; P<.001). In the subgroup analysis, studies in which prophylactic iron or vitamin B₁₂ was administered lost significance in the odds ratio for postoperative vitamin B₁₂ deficiency.ConclusionThe authors’ findings suggest that SG is more beneficial than RYGB with regard to postoperative vitamin B₁₂ deficiency risk, whereas the 2 methods are comparable with regard to the risk of postoperative anemia and iron deficiency. Postoperative prophylactic iron and B₁₂ supplementation, in addition to general multivitamin and mineral supplementation, is recommended based on the comparable deficiency risk of the 2 methods as indicated by subgroup analysis.     

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for complications: outcomes from a tertiary referral center in the Middle East

BackgroundComplications after sleeve gastrectomy (SG) unfortunately lead a subset of patients to require revisional surgery, including conversion to Roux-en-Y gastric bypass (RYGB).ObjectivesWe aimed to describe the indications for conversion and perioperative outcomes in this subset of patients.SettingAcademic hospital, Abu Dhabi, United Arab Emirates.MethodsAll patients undergoing conversion from SG to RYGB from September 2015 to December 2018 were retrospectively reviewed. Patients who underwent conversion solely for weight recidivism were excluded from analysis.ResultsForty-seven patients underwent conversion to RYGB due to complications from SG. The cohort was 76.5% female with a mean age of 39 years and median body mass index of 34 kg/m². The median time between SG and RYGB was 36 months. Indications warranting conversion included mechanical complications (n = 24, 51.1%), intractable reflux (n = 21, 44.7%), and fistula (n = 2, 4.2%). Preoperative mechanical abnormalities included hiatal hernia (n = 13, 27.7%), helical twist (n = 10, 21.3%), sleeve stenosis/stricture (n = 5, 10.6%), fistula (n = 2, 4.2%), and leak (n = 1, 2.1%). Each conversion was completed with a laparoscopic approach, with a median length of stay of 3 days. Four patients (8.5%) experienced complications within 30 days, including 2 patients (4.2%) with superficial surgical site infection, 1 patient each (2.1%) with gastrointestinal hemorrhage and anastomotic leak. There were no mortalities at a median follow-up of 17 months.ConclusionIn this series, representing the largest reported single-center experience in the Middle East, conversion of SG to RYGB was safe and effective for the treatment of symptoms and mechanical complications after SG.     

Metabolic comparison of one-anastomosis gastric bypass,single-anastomosis duodenal-switch,Roux-en-Y gastric bypass,and vertical sleeve gastrectomy in rat

Background

One-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal switch (SADS) have become increasingly popular weight loss strategies. However, data directly comparing the effectiveness of these procedures with Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are limited.

Comparison of weight loss outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy in a racially mixed urban patient population

BackgroundNational data show a trend favoring laparoscopic sleeve gastrectomy (SG) over Roux-en-Y gastric bypass (RYGB). Published data demonstrating the differences in weight loss between the two procedures are mixed.ObjectiveIn this retrospective study using clinical data from 2010 to 2020, we compared the clinical and demographic characteristics of patients undergoing either SG or RYGB to evaluate their long-term weight loss outcomes.SettingUniversity hospital in the United States.MethodsA total of 3329 patients were identified in our institutional Metabolic and Bariatric Surgery Accreditation and Quality Improvement database using Current Procedural Terminology codes for either RYGB or SG. A general linear model was used for baseline characteristics. Logistic regression was used for factors favoring RYGB versus SG. A multivariable linear mixed model was used for weight-trajectory analysis. Cox regression was used for a cumulative hazard ratio of 10% weight regained from nadir.ResultsFactors favoring RYGB were diagnoses of type 2 diabetes and gastroesophageal reflux disease, Hispanic ethnicity, and surgeon’s preference. SG was favored among Black patients and smokers. RYGB was associated with more weight loss at all time points. The risk of weight regain was significantly higher after SG versus RYGB.ConclusionsThe bariatric procedure choice is significantly influenced by race, medical history, and surgeon’s experience. RYGB results in a significantly more durable weight loss compared with SG regardless of race or other stratification factors.     

Esophageal cancer after sleeve gastrectomy: a population-based comparative cohort study

BackgroundSleeve gastrectomy (SG) is the most common bariatric surgery; however, this approach may induce gastroesophageal reflux disease (GERD). Both obesity and GERD are independent risk factors for esophageal cancer, however the impact of SG on risk of esophageal cancer remains unknown.ObjectiveTo evaluate the risk of esophageal cancer after reflux-prone bariatric surgery.SettingPopulation-level, provincial administrative healthcare database, Quebec, Canada.MethodsWe identified a population-based cohort of all patients with obesity who underwent reflux-prone surgery (SG and duodenal switch [DS]) or reflux-protective Roux-en-Y gastric bypass (RYGB) during 01/2006–12/2012 in Quebec, Canada. For every surgical patient, 2-3 nonsurgical controls with obesity matched for age, sex, and geography were also identified. Crude incidence rate ratios (IRRs) for esophageal cancer were calculated using person-time analysis. Hazard ratios (HRs) were obtained using multivariate cox regression.ResultsA total of 4121 patients had reflux-prone procedures and 852 underwent RYGB. At a mean follow-up of 7.6 years, 8 cases of esophageal cancer were identified after bariatric surgery. Compared with RYGB, IRR for esophageal cancer in reflux-prone group was 1.45 (95%CI: .19–65.5) and HR = .83 (95%CI: .10–7.27). The crude incidence rate of esophageal cancer in the reflux-prone group was higher than that of nonsurgical controls (n = 12,159; IRR = 3.46, 95%CI: 1.00–12.5), but after adjustment the difference disappeared (HR = 2.47, 95%CI: .82–7.45).ConclusionsLong-term incidence of esophageal cancer after reflux-prone bariatric surgery is not greater than RYGB. While crude incidence of esophageal cancer after reflux-prone surgery is higher than in nonsurgical patients with obesity, such difference disappears after accounting for confounders. Given the low incidence of esophageal cancer and slow progression of dysplastic Barrett esophagus, studies with longer follow-up are needed.     

Weight loss specific to indication,remission of diabetes,and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis

Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%–63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%–25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%–59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%–28%) in 12 studies (n = 219), and medium-term (2–5 yr) outcomes were 45.8% EWL (95% CI, 38%–53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%–26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%–72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%–8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.     

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

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.     

Prospective clinical cohort study: low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass

BackgroundGastroesophageal reflux disease seems more frequent after laparoscopic sleeve gastrectomy (LSG) than Roux-en-Y gastric bypass (LRYGB). Retrospective case series have raised concerns about a high incidence of Barrett esophagus (BE) after LSG.ObjectiveThis prospective clinical cohort study compared the incidence of BE ≥5 years after LSG and LRYGB.SettingSt. Clara Hospital, Basel, and University Hospital, Zürich, Switzerland.MethodsPatients were recruited from 2 bariatric centers where preoperative gastroscopy is standard practice and LRYGB is preferred for patients with preexisting gastroesophageal reflux disease. At follow-up ≥5 years after surgery, patients underwent gastroscopy with quadrantic biopsies from the squamocolumnar junction and metaplastic segment. Symptoms were assessed using validated questionnaires. Wireless pH measurement assessed esophageal acid exposure.ResultsA total of 169 patients were included, with a median 7.0 ± 1.5 years after surgery. In the LSG group (n = 83), 3 patients had endoscopically and histologically confirmed de novo BE; in the LRYGB group (n = 86), there were 2 patients with BE, 1 de novo and 1 preexisting (de novo BE, 3.6% versus 1.2%; P = .362). At follow-up, reflux symptoms were reported more frequently by the LSG group than by the LRYGB group (51.9% versus 10.5%). Similarly, moderate-to-severe reflux esophagitis (Los Angeles grade B–D) was more common (27.7% versus 5.8%) despite greater use of proton pump inhibitors (49.4% versus 19.7%), and pathologic acid exposure was more frequent in patients who underwent LSG than in patients who underwent LRYGB.ConclusionsAfter at least 5 years of follow-up, a higher incidence of reflux symptoms, reflux esophagitis, and pathologic esophageal acid exposure was found in patients who underwent LSG compared with patients who underwent LRYGB. However, the incidence of BE after LSG was low and not significantly different between the 2 groups.