Greater durability of weight loss at ten years with gastric bypass compared to sleeve gastrectomy.

Introduction: Sleeve gastrectomy (SG) and gastric bypass (GB) are the most commonly performed bariatric surgeries. However, there is insufficient data on which leads to greater long-term (10 year) weight loss.

Methods: Subjects who underwent SG and GB from 2008-2013 were followed up at 2, 5, and 10 years post-operatively for weight and diabetes (DM) outcomes. Percentage total weight loss (%TWL), weight regain ( ≥ 20% from nadir) and DM remission rates were compared.

Results: Subjects (n = 253) who underwent SG (60.9%) and GB (39.1%) were included. The mean age was 41.4 ± 10.6 y, 39.1% were male, and the mean body mass index was 42.1 ± 9.3 kg/m² with no significant difference between groups. The GB group had a greater proportion of subjects with DM (83.8% vs 19.5%, p < 0.001). At 2 y, %TWL was comparable (GB: 22.3 ± 9.6%, SG: 22.6 ± 10.5%, p = 0.824). However, those who underwent GB had significantly higher %TWL at 5 y (GB: 21.5 ± 8.9%, SG 18.0 ± 11.3%, p = 0.029) and 10 y (GB: 21.0 ± 9.0%, SG: 15.4 ± 12.1%, p = 0.001). The rate of significant weight regain was higher amongst the SG group at both 5 y (SG: 14.7%, GB: 3.8%, p = 0.018) and 10 y (SG: 27.9%, GB: 13.7%, p = 0.037) post-operatively. On multiple linear regression, GB remained significantly associated with greater %TWL at 10 y compared to SG (b = 5.51; adjusted p-value = 0.013), after adjusting for age, sex, pre-operative BMI, pre-operative glycemic status, and surgery year. There was no difference in DM remission rates at 10 y (SG: 26.7%, GB: 19.1%, p = 0.385).

Conclusion: GB was able to produce greater %TWL and less weight regain than SG at 5 and 10 years post-operatively. There was no difference in long-term DM remission rates between the two surgeries.