Beyond 5 years: a matched cohort of sleeve gastrectomy versus gastric bypass


      • There is limited long term data of patients after laparoscopic sleeve gastrectomy
      • 75 sleeve patients identified and matched by age, sex, and BMI with bypass patients
      • Bypass patients had significantly more weight loss than sleeve patients
      • No difference seen in patients with follow-up in bariatric clinic vs other setting



      Laparoscopic sleeve gastrectomy (LSG) has demonstrated excellent short-term outcomes. However, existing studies suffer from loss to follow-up, and most long-term data focus on laparoscopic Roux-en-Y gastric bypass (LRYGB). This study compares weight loss in patients ≥5 years from LSG with that in matched patients who underwent LRYGB.


      The purpose of this study was to compare long-term weight loss in patients undergoing LRYGB and LSG.


      University hospital, United States.


      We retrospectively evaluated patients who underwent LSG before August 2012 with follow-up data ≥5 years. LSG patients were matched 1:1 with LRYGB patients by sex, age at surgery, and preoperative body mass index. Univariate and multivariate analyses were performed with weight loss at the longest duration the primary outcome.


      One-hundred and sixty-five patients underwent LSG during the study period. Long-term follow-up data (≥5 years) were available for 85 patients (52%). There were no preoperative differences between those with and without follow-up data. Six LSG patients (7%) were excluded because they underwent reoperation that altered intestinal anatomy. Of the 79 patients remaining, 75 were matched with post-LRYGB patients. The average follow-up period was 6.4 years for LSG patients and 6.5 years for LRYGB patients (P = .08, not significant). Change in body mass index was 6.81 kg/m2 for LSG patients and 13.11 kg/m2 for LRYGB patients. Percentage of total body weight loss was 15.25% for LSG patients and 28.73% for LRYGB patients. Percentage of excess body weight loss was 37% for LSG patients and 67% for LRYGB patients (P < .0001). Weight loss for LSG patient follow-up in clinic versus outside the clinic was 46% versus 34% (P = .18, not significant).


      LSG is now the most common bariatric surgery in the United States. Long-term data are needed to confirm that observed short-term favorable outcomes are maintained. Recent studies have produced divergent results. We observed significantly less weight loss at ≥5 years in LSG patients compared with matched LRYGB patients.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • English W.J.
        • DeMaria E.J.
        • Brethauer S.A.
        • Mattar S.G.
        • Rosenthal R.J.
        • Morton J.M.
        American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016.
        Surg Obes Relat Dis. 2018; 14: 259-263
      1. American Society of Metabolic and Bariatric Surgery [homepage on the Internet]. Newberry: The Society.
        (c2022 [updated 2021 Mar; cited 2019 Dec 7]. Estimate of bariatric surgery numbers, 2011-2019; [about 1 screen]. Available from:)
        • Boza C.
        • Salinas J.
        • Salgado N.
        • et al.
        Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up.
        Obes Surg. 2012; 22: 866-871
        • Shoar S.
        • Saber A.A.
        Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies.
        Surg Obes Relat Dis. 2017; 13: 170-180
        • Brethauer S.A.
        • Kim J.
        • El Chaar M.
        • et al.
        Standardized outcomes reporting in metabolic and bariatric surgery.
        Obes Surg. 2015; 25: 587-606
        • Puzziferri N.
        • Roshek T.B.
        • Mayo H.G.
        • Gallagher R.
        • Belle S.H.
        • Livingston E.H.
        Long-term follow-up after bariatric surgery: a systematic review.
        JAMA. 2014; 312: 934-942
        • Salminen P.
        • Helmiö M.
        • Ovaska J.
        • et al.
        Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial.
        JAMA. 2018; 319: 241-254
        • Peterli R.
        • Wölnerhanssen B.K.
        • Peters T.
        • et al.
        Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial.
        JAMA. 2018; 319: 255-265
        • Ahmed B.
        • King W.C.
        • Gourash W.
        • et al.
        Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study.
        Surgery. 2018; 164: 774-783
        • Azagury D.
        • Papasavas P.
        • Hamdallah I.
        • Gagner M.
        • Kim J.
        ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures.
        Surg Obes Relat Dis. 2018; 14: 1425-1441