Sleeve gastrectomy vs. Roux-en-Y gastric bypass

Sleeve gastrectomy vs. Roux-en-Y gastric bypass for type 2 diabetes remission in patients with severe obesity: an individual patient data meta-analysis (IPDMA)

Severe obesity is a global epidemic, which is still increasing worldwide. Obesity is a chronic progressive disease resulting from multiple factors causing numerous obesity-related comorbidities and health risks and also early mortality. Management of severe obesity should involve multidisciplinary approaches and be life-long. Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity, resulting in substantial sustained weight reduction with improvement in comorbidities, quality of life (QOL), and increased life expectancy.

Obesity is not merely a risk factor, but a chronic disease requiring lifelong therapy.The chronic nature of the disease of obesity requires long-term follow-up to show efficiency of the chosen treatment underlining the need for long-term follow-up. All MBS operations should be judged for their long-term effects and all novel MBS procedures should be compared with standard operations before they are used in routine clinical practice. Laparoscopic sleeve gastrectomy (SG, resection of ~75% of the stomach) and Roux-en-Y gastric bypass (RYGB, creation of a small gastric pouch connecting this newly created pouch to small intestine and bypassing the first section of the small intestine) are the two most common MBS techniques worldwide.

 MBS is associated with substantially lower all-cause mortality rates and longer life expectancy. These survival benefits are much more pronounced for patients with preoperative type 2 diabetes (T2D) further underlining the need to detect differences between the two most common MBS procedures in T2D remission and the related cardiovascular and other end-organ complications, such as kidney failure. Randomized clinical trials (RCTs) are the most robust study designs for evaluating health care interventions. In practice all RCTs comparing SG and RYGB with sufficient long-term follow-up are so far statistically underpowered to detect clinically significant differences.

The individual patient data meta-analysis (IPDMA) will include all patients with type 2 diabetes from all RCTs comparing SG and RYGB and the overall number of patients with T2D will have sufficient statistical power to compare the two procedures to optimize the procedure selection for patients with T2D and severe obesity.