Laparoscopic Sleeve Gastrectomy Versus Roux-Y-Gastric Bypass for Morbid Obesity-3-Year Outcomes of the Prospective Randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS).
Laparoscopic sleeve gastrectomy (LSG) is performed almost as often in Europe as laparoscopic Roux-Y-Gastric Bypass (LRYGB). We present the 3-year interim results of the 5-year prospective, randomized trial comparing the 2 procedures (Swiss Multicentre Bypass Or Sleeve Study; SM-BOSS).



Initially, 217 patients (LSG, n = 107; LRYGB, n = 110) were randomized to receive either LSG or LRYGB at 4 bariatric centers in Switzerland. Mean body mass index of all patients was 44 ± 11 kg/m, mean age was 43 ± 5.3 years, and 72% of patients were female. Minimal follow-up was 3 years with a rate of 97%. Both groups were compared for weight loss, comorbidities, quality of life, and complications.



Excessive body mass index loss was similar between LSG and LRYGB at each time point (1 year: 72.3 ± 21.9% vs. 76.6 ± 20.9%, P = 0.139; 2 years: 74.7 ± 29.8% vs. 77.7 ± 30%, P = 0.513; 3 years: 70.9 ± 23.8% vs. 73.8 ± 23.3%, P = 0.316). At this interim 3-year time point, comorbidities were significantly reduced and comparable after both procedures except for gastro-esophageal reflux disease and dyslipidemia, which were more successfully treated by LRYGB. Quality of life increased significantly in both groups after 1, 2, and 3 years postsurgery. There was no statistically significant difference in number of complications treated by reoperation (LSG, n = 9; LRYGB, n = 16, P = 0.15) or number of complications treated conservatively.



In this trial, LSG and LRYGB are equally efficient regarding weight loss, quality of life, and complications up to 3 years postsurgery. Improvement of comorbidities is similar except for gastro-esophageal reflux disease and dyslipidemia that appear to be more successfully treated by LRYGB.
*Department of Surgery, St. Claraspital, Basel, Switzerland†Department of Research, St. Claraspital, Basel, Switzerland‡Department of Biomedicine, University Hospital of Basel, Basel, Switzerland§Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland¶Department of Surgery, University Hospital Bern, Bern, Switzerland||Department of Internal Medicine, St. Claraspital, Basel, Switzerland**Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland††eSwiss Medical and Surgical Center, St. Gallen, Switzerland‡‡Department of Clinical Pharmacology, University Hospital Basel, Basel, Switzerland.
Ralph
R
Peterli
Bettina Karin
BK
Wölnerhanssen
Diana
D
Vetter
Philipp
P
Nett
Markus
M
Gass
Yves
Y
Borbély
Thomas
T
Peters
Marc
M
Schiesser
Bernd
B
Schultes
Christoph
C
Beglinger
Juergen
J
Drewe
Marco
M
Bueter
D000328:Adult; D000704:Analysis of Variance; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss