Long-Term Outcomes in Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis of Randomized Trials

作者：Monteiro Delgado L, Fabretina de Souza V, Fontel Pompeu B, de Moraes Ogawa T, Pereira Oliveira H, Sacksida Valladão VDC, Lima Castelo Branco Marques FI · 发表于：Obesity surgery · 年份：2025 · DOI：10.1007/s11695-025-08044-8 · 研究领域：Bariatric surgery、Diabetes remission、Meta-analysis、Obesity、Roux-en-Y gastric bypass、Sleeve gastrectomy、Weight loss

Obesity is a global health concern linked to metabolic and cardiovascular complications. Bariatric surgery is an effective treatment, with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) being the most studied procedures. This systematic review and meta-analysis compare the long-term efficacy and safety of SG and RYGB. We searched PubMed, Embase, and the Cochrane Library until May 20, 2024, for randomized trials with ≥ 5 years of follow-up comparing SG and RYGB. Primary outcomes included excess weight loss (EWL), total weight loss (TWL), and excess BMI loss (EBL). Secondary outcomes included diabetes remission, HbA1c levels, obesity-related comorbidities, complications, and mortality. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. We included 9 randomized trials encompassing 1,489 patients. RYGB resulted in significantly greater EWL (MD -14.00%; 95% CI -20.65 to -7.35), TWL (MD -5.67%; 95% CI -8.81 to -2.52), and EBL (MD -7.44%; 95% CI -10.54 to -4.34) compared to SG. T2DM remission was higher in the RYGB group (RR 0.72; 95% CI 0.54-0.97), although HbA1c levels were similar between groups. RYGB also led to greater improvement in GERD symptoms (RR 0.48; 95% CI 0.31-0.74). No significant differences were observed between SG and RYGB in dyslipidemia, hypertension, obstructive sleep apnea syndrome (OSAS), or joint pain. Regarding safety, SG was associated with significantly lower late major co...