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- Title
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.
- Authors
Peterli, Ralph; Wölnerhanssen, Bettina Karin; Peters, Thomas; Vetter, Diana; Kröll, Dino; Borbély, Yves; Schultes, Bernd; Beglinger, Christoph; Drewe, Jürgen; Schiesser, Marc; Nett, Philipp; Bueter, Marco; Wölnerhanssen, Bettina Karin; Kröll, Dino; Borbély, Yves; Drewe, Jürgen
- Abstract
<bold>Importance: </bold>Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown.<bold>Objective: </bold>To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events.<bold>Design, Setting, and Participants: </bold>The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period.<bold>Interventions: </bold>Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110).<bold>Main Outcomes and Measures: </bold>The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events.<bold>Results: </bold>Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, -7.18%; 95% CI, -14.30% to -0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass.<bold>Conclusions and Relevance: </bold>Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT00356213.
- Subjects
GASTRECTOMY; GASTRIC bypass; LAPAROSCOPIC surgery; BARIATRIC surgery; MORBID obesity; THERAPEUTICS; COMPARATIVE studies; GASTROESOPHAGEAL reflux; LAPAROSCOPY; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; QUALITY of life; RESEARCH; STATISTICAL sampling; SURGICAL complications; WEIGHT loss; EVALUATION research; BODY mass index; DISEASE complications
- Publication
JAMA: Journal of the American Medical Association, 2018, Vol 319, Issue 3, p255
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2017.20897