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Background <p>Laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed bariatric procedures worldwide. Trials and observational studies up to five years show RYGB yields slightly greater weight loss and better metabolic control, notably for dyslipidemia and reflux. Ten-year cohorts and recent randomized trials give perspective on durability differences, but small sample sizes and single-center designs limit their reach. No meta-analysis has yet pooled these decade-long data, leaving clinicians without clear guidance on the comparative long-term performance of SG and RYGB.</p> Objective <p>This meta-analysis aims to compare the 10-year outcomes of SG versus RYGB in terms of weight loss and remission of comorbidities.</p> Methods <p>We performed a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational cohorts with a minimum 10-year follow-up. We searched PubMed, Embase, and Cochrane through April 2025. Primary endpoints were percent total weight loss (%TWL) and percent excess weight loss (%EWL). Secondary endpoints were remission of type 2 diabetes (T2D), hypertension, and dyslipidemia. Data were pooled using a random-effects model with risk ratio (RR) and mean difference (MD). Statistical analysis were made using R v.4.3.5.</p> Results <p>RYGB produced greater long-term weight loss than SG (%TWL mean difference −2.38, 95% CI − 3.85 to − 0.92, <i>p</i> = 0.001; %EWL mean difference − 4.92, 95% CI − 8.67 to − 1.17, <i>p</i> = 0.01). Remission of T2D (RR 0.88, 95% CI 0.67 to 1.15, <i>p</i> = 0.36) and dyslipidemia (RR 0.84, 95% CI 0.64 to 1.09, <i>p</i> = 0.18) did not differ. Hypertension remission trended toward RYGB without reaching significance (RR 0.68, 95% CI 0.39 to 1.20, <i>p</i> = 0.19). SG showed higher rates of de-novo or worsening gastro-esophageal reflux disease and a markedly higher conversion to RYGB.</p> Conclusion <p>The decadal outcomes of SG and RYGB reveal a level of parity that challenges historical procedural endorsements. Fidelity to the data indicates that ten years after surgery, there is no statistically or clinically significant difference in total weight loss or excess weight loss between the two techniques. Furthermore, the remission of major metabolic comorbidities, including type 2 diabetes and dyslipidemia, is comparable across both cohorts.</p>

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Ten-Year Follow-Up for Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月2日

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  • Mohamed Chouky Kamar,
  • Pablo Enrique Astudillo Coello,
  • Amanda Vitória Rodrigues dos Santos,
  • Silviane Leite Melo

摘要

Background

Laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed bariatric procedures worldwide. Trials and observational studies up to five years show RYGB yields slightly greater weight loss and better metabolic control, notably for dyslipidemia and reflux. Ten-year cohorts and recent randomized trials give perspective on durability differences, but small sample sizes and single-center designs limit their reach. No meta-analysis has yet pooled these decade-long data, leaving clinicians without clear guidance on the comparative long-term performance of SG and RYGB.

Objective

This meta-analysis aims to compare the 10-year outcomes of SG versus RYGB in terms of weight loss and remission of comorbidities.

Methods

We performed a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational cohorts with a minimum 10-year follow-up. We searched PubMed, Embase, and Cochrane through April 2025. Primary endpoints were percent total weight loss (%TWL) and percent excess weight loss (%EWL). Secondary endpoints were remission of type 2 diabetes (T2D), hypertension, and dyslipidemia. Data were pooled using a random-effects model with risk ratio (RR) and mean difference (MD). Statistical analysis were made using R v.4.3.5.

Results

RYGB produced greater long-term weight loss than SG (%TWL mean difference −2.38, 95% CI − 3.85 to − 0.92, p = 0.001; %EWL mean difference − 4.92, 95% CI − 8.67 to − 1.17, p = 0.01). Remission of T2D (RR 0.88, 95% CI 0.67 to 1.15, p = 0.36) and dyslipidemia (RR 0.84, 95% CI 0.64 to 1.09, p = 0.18) did not differ. Hypertension remission trended toward RYGB without reaching significance (RR 0.68, 95% CI 0.39 to 1.20, p = 0.19). SG showed higher rates of de-novo or worsening gastro-esophageal reflux disease and a markedly higher conversion to RYGB.

Conclusion

The decadal outcomes of SG and RYGB reveal a level of parity that challenges historical procedural endorsements. Fidelity to the data indicates that ten years after surgery, there is no statistically or clinically significant difference in total weight loss or excess weight loss between the two techniques. Furthermore, the remission of major metabolic comorbidities, including type 2 diabetes and dyslipidemia, is comparable across both cohorts.