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ORLANDO -- Five years following surgery, Roux-en-Y gastric bypass patients had greater weight loss versus sleeve gastrectomy patients, researchers reported here.

In a retrospective analysis presented during ENDO 2017, Corey J. Lager, MD, of the University of Michigan in Ann Arbor, and colleagues found excess weight loss at last follow-up was greater for patients who underwent Roux-en-Y gastric compared to those undergoing sleeve gastrectomy (54.5% ± 32.5% versus 38.7% ± 23.1%; P<0.0001). Change in BMI was also slightly greater among the gastric bypass group after five years (-11.4 ± 7.2 versus -11.1 ± 11.6; P=0.02).

Gastric bypass patients also showed greater weight loss and greater reduction in BMI at one year post-surgery, the researchers found.

Lager's group followed 380 gastric bypass and 336 sleeve gastrectomy patients from the Post-Bariatric Endocrine Clinic, measuring weight loss, BMI, HbA1c levels, and blood pressure annually throughout the five-year study.

At baseline, researchers reported nearly all variables were notably lower among participants who underwent gastric bypass, including BMI and total weight measures (47.3 ± 8.2 BMI; 133.2 ± 27.1 kg) compared to sleeve gastrectomy (50.3 ± 10.9 BMI; 142.8 ± 33.6 kg). However, measures for blood pressure between both groups were similar throughout the follow-up period.

Lager notes that while measures of each variable throughout the study favored gastric bypass, he questions whether the extent of clinical significance to change in BMI, particularly after the three-year post-surgery mark. While life-threatening complications were rare throughout the study and did not significantly vary between the two groups, researchers reported that mild complications were less prevalent in the sleeve gastrectomy group, which mostly included infections and hemorrhage.

Despite the dropout rate, which included only 188 participants from the gastric bypass and 93 participants from the sleeve gastrectomy remaining through the duration of the five-year study, Lager stated he was pleased with their rate of follow-up, noting that this population tends to have limited follow-ups.

While both laparoscopic procedures are the most popular forms of bariatric surgery, the sleeve gastrectomy has been growing in popularity as of late, in part attributed to differences in insurance coverage and potential for fewer surgical complications, Lager notes that there is a lack of previous studies comparing the long-term outcomes of both procedures.

In response to a question posed by a bariatric surgeon regarding what to recommend for patients, Lager responded, "Our main question was, has the pendulum swung too quickly in favor of sleeve gastrectomy? Should it be 90+% of surgeries? And the answer to that is probably no, it shouldn't be that many of the surgeries."

Ultimately, he recommended weighing the risk and rewards of each surgery against the patient's needs and hopes, highlighting the choice between surgery options is an individualized decision.

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