Abstract:
Introduction: The long-term effectiveness of different bariatric procedures remains an area of active investigation. This study aims to compare the long-term outcomes of Laparoscopic Sleeve Gastrectomy (LSG), Roux-en-Y Gastric Bypass (RYGB), and One-Anastomosis Gastric Bypass (OAGB) in patients with morbid obesity, with a minimum follow-up period of five years. We assessed weight loss outcomes, the impact on comorbidities, and overall quality of life (QoL) to provide insights into the sustainability and effectiveness of each procedure.
Methods: We conducted a retrospective analysis of prospectively collected data from morbidly obese patients who underwent LSG, RYGB, or OAGB between January 2008 and December 2017. Patients were stratified into three groups based on their procedure. We compared percentage excess BMI loss (%EBMIL) at 5, 7, and 10 years, in addition to evaluating improvements in type 2 diabetes mellitus (T2DM), hypertension (HTN), obstructive sleep apnoea (OSA), and overall QoL.
Results: A total of 396 patients were included in the study:
- LSG: 292 patients
- RYGB: 83 patients
- OAGB: 21 patients
The mean age and BMI were comparable among the groups:
- LSG: 39.8 ± 11 years, BMI 46.4 ± 7.6 kg/m²
- RYGB: 41.85 ± 10.3 years, BMI 44.88 ± 6.7 kg/m²
- OAGB: 39.64 ± 10.6 years, BMI 51.35 ± 5.82 kg/m²
The %EBMIL outcomes were as follows:
- At 5 years: LSG (58.22 ± 25.7%), RYGB (72.21 ± 24.2%), OAGB (77.31 ± 12.4%)
- At 7 years: LSG (51.58 ± 28.9%), RYGB (69.66 ± 24.3%), OAGB (75.41 ± 18.8%)
- At 10 years: LSG (50.36 ± 26.1%), RYGB (68.37 ± 18.6%) (OAGB sample was too small for statistical comparison)
Statistically significant differences (p < 0.05) were observed in weight loss outcomes, with OAGB showing a trend toward greater long-term weight loss compared to RYGB and LSG. However, the comorbidity resolution (T2DM, HTN, and OSA) and QoL scores were similar across all groups (p > 0.05), suggesting that all three procedures provide significant health benefits beyond weight loss.
Conclusion: This study highlights that LSG, RYGB, and OAGB all result in sustained long-term weight loss and remission of major comorbidities. While OAGB and RYGB demonstrated comparable efficacy in comorbidity resolution, LSG showed relatively favourable metabolic outcomes. Additionally, OAGB appeared to have better long-term weight loss and lower weight regain than RYGB and LSG, though the small sample size for OAGB limits definitive conclusions. Further large-scale studies are necessary to validate these findings.
Overall, quality of life (QoL), measured using the GIQLI and BAROS scales, was significantly improved across all three groups, indicating that bariatric surgery is an effective long-term intervention for morbid obesity and associated comorbidities.
