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Sleeve Gastrectomy (SG) is the most prevalent bariatric operation worldwide. It represents more than 70% of primary bariatric procedures, even in ambulatory surgery. There are some exceptions, such as Latin America, where SG is only 31% of all procedures and Roux-en-Y Gastric Bypass (RYGB) is still more frequently performed.
The reasons for SG to be the most performed procedure are reviewed by Dr. Gagner in this lecture.
In the first place, it is a less risky procedure: fewer leaks and lower morbidity and mortality have been described. A 50% higher mortality for RYGB compared to SG has been described. More major re-interventions with life-threatening complications can be seen after RYGB, affecting up to a quarter of patients.
Two large trials comparing SG-RYGB have not shown many differences in terms of weight loss, diabetes/hypertension remission, GERD or quality of life. Nevertheless, there is an ongoing Swedish trial including 2100 patients comparing outcomes after a 5-year follow-up following both procedures that will provide more evidence in this regard.
Type 2 Diabetes remission at 5 years descends to 25%, but after SG there are still other surgical options to improve outcomes, as well as for weight regain.
In the other hand, a higher rate of revision surgery has been described after SG. However, we should take into account that a two-step operation is the therapeutic strategy for patients with high BMI who undergo a SG in the first place.
Regarding oncologic concerns, esophageal carcinoma after RYGB, SG and duodenal switch in the long-term has shown no different rates. The same happens with GERD, esophagitis and Barrett’s esophagus. Also, tumors in the remnant stomach after RYGB have been described and can be difficult to diagnose.
In summary, SG is a less morbid procedure with similar outcomes compared with RYGB, has less mortality and has more further revisional surgical options.
