The last 30 years have brought a dramatic increase in obesity worldwide. Bariatric surgery is currently the only efficient treatment option leading to sustainable weight loss and a reduction in comorbidities in morbidly obese patients. Therefore, there has been a continuously rapid growth in the number of bariatric interventions. There are a multitude of different surgical procedures and each procedure has its own profile of advantages and disadvantages. So far there is no clear consensus on which procedure should be applied in each case.
Laparoscopic gastric banding temporarily gained popularity due to its easy application and reversibility. In the meantime, an increasing number of trials have shown the considerable drawbacks of this procedure (low level of efficiency combined with poor quality of life and a high reoperation rate), and this procedure has more or less been abandoned in Europe.
Until recently, the Roux-en-Y gastric bypass was regarded as the standard bariatric procedure. However, the sleeve gastrectomy is being performed with increasing frequency despite a lack of evidence regarding its long-term efficacy. The sleeve gastrectomy procedure is technically easier, faster to perform, and potentially safer compared to the Roux-en-Y gastric bypass. However, much more data on clinical and metabolic long-term outcomes is available on the Roux-en-Y gastric bypass procedure. The early and midterm results of sleeve gastrectomy showed potential benefit, but only a limited number of randomized studies have compared the outcomes of the sleeve gastrectomy and the Roux-en-Y gastric bypass head to head, most of which were underpowered because of low patient numbers, short follow-up, or both.
In this lecture, Professor Ralph Peterli, explains the results of the SM-BOSS Randomized Clinical Trial that compares differences between the sleeve gastrectomy and the Roux-en-Y gastric bypass in the treatment of morbid obesity in terms of weight loss, changes in comorbidities, quality of life, and adverse events.