Gastric sleeve and gastric bypass: changes in weight after two-year follow-up - which is more effective?ABSTRACT
Background: Bariatric surgery is currently the gold standard for the treatment of obesity. However, weight recurrence varies among the different surgical methods.
Aims: To compare changes in weight one and two years after bariatric surgery considering the gastric bypass and gastric sleeve methods.
Methods: A cross-sectional study was conducted at a hospital with adults of both sexes followed up for two years after surgery. Anthropometric, sociodemographic, clinical, and lifestyle characteristics were analyzed.
Results: A total of 184 patients, predominantly women (82.1%), were assessed (136 submitted to gastric sleeve and 48 to gastric bypass). Good adherence to the multivitamin, but not to diet or physical activity, was verified in both groups. The percentages of weight loss and excess weight loss were higher in the gastric bypass group (one year after surgery: p<0.001 and p=0.010, respectively; two years after surgery: p<0.001 and p<0.001, respectively). Average weight gain was 2.37 kg and higher after gastric sleeve (p=0.042), whereas no difference between methods was found for the percentage of weight recurrence. Weight loss and recurrence at the two-year follow-up were influenced by diet in both groups. The percentage of weight loss was higher after gastric bypass one and two years after surgery. Weight recurrence was higher after the gastric sleeve method, without interfering with the surgical success of the technique.
Conclusions: We verified greater efficacy in the gastric bypass technique in terms of weight loss at 12 and 24 months postoperatively. Weight recurrence was found 24 months after both methods, especially in the gastric sleeve group, without constituting surgical failure.
Keywords:
Bariatric Surgery; Obesity; Weight Loss; Weight Gain
ARTICLE HIGHLIGHTS
• Gastric bypass promoted greater weight loss at 12 and 24 months compared to the gastric sleeve method;
• Weight recurrence two years after surgery was greater in the gastric sleeve group;
• Weight recurrence was found with both surgical techniques, but without constituting surgical failure;
• Adherence to diet and physical activity exerted an influence on both weight loss and recurrence.
CENTRAL MESSAGE Bariatric surgery is considered the gold standard for the treatment of obesity that is difficult to control clinically. Such surgery is recommended by the main guidelines due to its short- and long-term effectiveness. Among the authorized surgical techniques, gastric bypass and gastric sleeve are the most widely performed throughout the world, with an increase in the indication for the latter. The results of these surgical interventions are satisfactory, with significant reductions in excess body weight. Weight recurrence is mainly associated with unhealthy lifestyle and/or long-term physiological and anatomical adaptations. Thus, studies comparing weight recurrence between the two surgical techniques are important so that the indication of each technique occurs in an individualized and assertive manner.
PERSPECTIVES The type of surgical technique exerted an influence on the percentage of weight loss (%WL) and percentage of excess weight loss (%EWL) at 12 and 24 months. Gastric bypass was better for achieving the surgical objective in both periods. Weight recurrence was only found at 24 months in both groups and was greater in the gastric sleeve group, but without constituting surgical failure. These results are relevant, and studies analyzing long-term weight recurrence are needed.
