Comparing the effects of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy on weight loss and comorbidity resolution: A systematic review and meta-analysis

Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric modalities. There is ongoing debate on the two modalities' long-term effects on weight loss and comorbidity resolution.PubMed, EMbase, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing LRYGB versus LSG were searched by March 2024. Quality assessment was conducted by Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, following the procedures outlined in the Cochrane Collaborations tool (RoB 2.0 Assessment Form).In total, 13 datasets were included from 10 RCTs that involved 1106 individuals. Both the percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) were greater in LRYGB compared to LSG at 3 years (MD: 13.04, 95%CI: 6.95-19.13; P < 0.0001) and 1 year (MD: 5.97, 95%CI: 5.23-6.71; P < 0.00001), respectively. When comparing LRYGB to LSG, the remission percentage for type 2 diabetes mellitus was greater at one (RR: 0.15, 95%CI: 0.03-0.27; P = 0.02) and 3 years (RR: 0.17, 95 % CI: 0.07-0.28; P = 0.001). Moreover, early (RR: 1.72, 95%CI: 1.19-2.46; P = 0.003) and late (RR: 1.40, 95%CI: 1.15-1.71; P = 0.001) adverse events were more common with LRYGB. Regarding remission from obstructive sleep apnea syndrome, dyslipidemia, and hypertension, no significant changes were seen. LRYGB and LSG are both viable bariatric surgery options for resolving long-term comorbidities. While the rate of adverse events is greater with LRYGB than LSG, the former may provide more long-term sustainable weight reduction.Additional research of a higher quality is necessary.