title: Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.
abstract: OBJECTIVE
  Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective alternative to the current standard procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB). Prospective data comparing both procedures are rare. Therefore, we performed a randomized clinical trial assessing the effectiveness and safety of these 2 operative techniques.
  
  
  METHODS
  Two hundred seventeen patients were randomized at 4 bariatric centers in Switzerland. One hundred seven patients underwent LSG using a 35-F bougie with suturing of the stapler line, and 110 patients underwent LRYGB with a 150-cm antecolic alimentary and a 50-cm biliopancreatic limb. The mean body mass index of all patients was 44 ± 11.1 kg/m, the mean age was 43 ± 5.3 years, and 72% were female.
  
  
  RESULTS
  The 2 groups were similar in terms of body mass index, age, sex, comorbidities, and eating behavior. The mean operative time was less for LSG than for LRYGB (87 ± 52.3 minutes vs 108 ± 42.3 minutes; P = 0.003). The conversion rate was 0.9% in both groups. Complications (<30 days) occurred more often in LRYGB than in LSG (17.2% vs 8.4%; P = 0.067). However, the difference in severe complications did not reach statistical significance (4.5% for LRYGB vs 1% for LSG; P = 0.21). Excessive body mass index loss 1 year after the operation was similar between the 2 groups (72.3% ± 22% for LSG and 76.6% ± 21% for LRYGB; P = 0.2). Except for gastroesophageal reflux disease, which showed a higher resolution rate after LRYGB, the comorbidities and quality of life were significantly improved after both procedures.
  
  
  CONCLUSIONS
  LSG was associated with shorter operation time and a trend toward fewer complications than with LRYGB. Both procedures were almost equally efficient regarding weight loss, improvement of comorbidities, and quality of life 1 year after surgery. Long-term follow-up data are needed to confirm these facts.
authors.affiliation: *Departments of Surgery and Internal Medicine, Claraspital, Basel, Switzerland †Departments of Surgery and Internal Medicine, Inselspital, Bern, Switzerland ‡Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland §Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zurich, Switzerland.
authors.forename: Ralph
authors.initials: R
authors.lastname: Peterli
authors.forename: Yves
authors.initials: Y
authors.lastname: Borbély
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kern
authors.forename: Markus
authors.initials: M
authors.lastname: Gass
authors.forename: Thomas
authors.initials: T
authors.lastname: Peters
authors.forename: Martin
authors.initials: M
authors.lastname: Thurnheer
authors.forename: Bernd
authors.initials: B
authors.lastname: Schultes
authors.forename: Kurt
authors.initials: K
authors.lastname: Laederach
authors.forename: Marco
authors.initials: M
authors.lastname: Bueter
authors.forename: Marc
authors.initials: M
authors.lastname: Schiesser
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D013557:Switzerland; D016896:Treatment Outcome; D015431:Weight Loss