Long-Term Comparative Effectiveness and Safety of Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass: An Umbrella Review
DOI:
https://doi.org/10.5281/zenodo.23163465Keywords:
Bariatric Surgery, Sleeve Gastrectomy, Roux-en-Y-Gastric Bypass, Metabolic SurgeryAbstract
Introduction: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most widely performed bariatric procedures for the treatment of obesity. However, uncertainty remains regarding their comparative effectiveness and long-term safety because of the heterogeneity of the available evidence. Methods: An umbrella review was conducted in accordance with the PRISMA 2020 guidelines. A systematic search was performed in PubMed/MEDLINE, Scopus, and Web of Science through May 2026. Systematic reviews, meta-analyses, and prospective studies comparing LSG and LRYGB in adults with obesity were included. Methodological quality was assessed using the AMSTAR-2 tool. Results: Twenty-two publications were included. LRYGB demonstrated greater weight loss and higher early remission rates of type 2 diabetes mellitus and dyslipidemia during the first five years; however, these differences diminished with follow-up exceeding 10 years. No significant differences were observed in hypertension remission. LSG was associated with a higher risk of gastroesophageal reflux disease, whereas LRYGB was associated with a greater incidence of nutritional deficiencies and reinterventions. Six reviews were rated as high quality and eleven as moderate quality. Discussion: Both procedures are effective but exhibit distinct benefits–risk profiles. The available evidence supports individualized surgical decision-making based on each patient's clinical, metabolic, and nutritional characteristics. Conclusion: LRYGB provides superior early metabolic outcomes, whereas LSG achieves comparable long-term results with a different complication profile. Procedure selection should be guided by a personalized patient-centered assessment.
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Copyright (c) 2026 Jorge Ramírez Kitchin, Fabiana Sazo Sapunar, Naomi Masso Villalobos, Beatriz Villalobos Tarqui, Paola González Berrios, Jorge Fernandez Cibils, Sebastián Muñoz Molina (Autor/a)
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