In their 2022 study published in JAMA Surgery, Salminen et al. presented 10-year follow-up results from the SLEEVEPASS randomised clinical trial, comparing laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with severe obesity. Their findings provide invaluable insights into the long-term efficacy and safety of these procedures, highlighting differences in weight loss, remission of comorbidities, and the prevalence of gastro-oesophageal reflux disease (GORD).
Overview
The SLEEVEPASS trial tracked 240 patients randomised to either LSG or LRYGB between 2008 and 2010. At the 10-year mark, both procedures demonstrated significant, sustained weight loss, with LRYGB achieving slightly superior outcomes. Specifically, LRYGB patients had a mean percentage excess weight loss (%EWL) of 51.9%, compared to 43.5% for LSG.
The procedures were broadly comparable in terms of comorbidity remission, but LRYGB showed notable advantages in hypertension remission (24% vs. 8%). However, LSG patients faced higher rates of GORD symptoms (49% vs. 9%) and oesophagitis (31% vs. 7%), suggesting that pre-existing reflux conditions may contraindicate LSG.
Key Findings
The study emphasises several critical findings:
Weight Loss: LRYGB delivered greater %EWL at 10 years, with an average difference of 8.4 percentage points.
GORD and Oesophagitis: LSG patients were more likely to develop GORD and required proton pump inhibitors (PPIs) more frequently, raising concerns about its suitability for patients with reflux.
Comorbidity Remission: Both procedures performed similarly in remission of diabetes and dyslipidaemia, though LRYGB excelled in treating hypertension.
Implications
The long-term outcomes of the SLEEVEPASS trial underscore the complexity of tailoring bariatric surgery to individual patient needs. While both procedures are effective for weight loss and comorbidity management, the elevated risk of GERD and oesophagitis with LSG warrants caution, particularly for patients with pre-existing reflux or hiatal hernias.
For healthcare providers, these findings stress the importance of comprehensive preoperative assessments and informed discussions with patients about the risks and benefits of each procedure.
Oliver’s Thoughts
Tailored Medicine is Key: The contrasting outcomes of LSG and LRYGB highlight the necessity of personalising surgical choices. A blanket approach to bariatric surgery can overlook critical patient-specific factors like GERD risk.
The GORD Factor: The higher rates of oesophagitis and GORD with LSG are striking and should be a red flag. For patients with reflux issues, bypass remains the superior choice.
10 Years, A Success Story: Despite the differences, the overarching message is clear—both procedures are transformative for patients with severe obesity, offering not just weight loss but improved quality of life and health outcomes.
The SLEEVEPASS trial delivers a nuanced view of bariatric surgery, reminding us that long-term success lies not just in the surgery itself but in the precision of its application.
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