Sleeve gastrectomy and Roux En Y gastric bypass: current state of metabolic surgery

PURPOSE OF REVIEW: Roux En Y gastric bypass (RYGB) is considered the bariatric gold standard. Recently, sleeve gastrectomy has gained significant popularity. Early evidence suggests sleeve gastrectomy as a well tolerated and efficacious alternative to RYGB. This article compares RYGB and sleeve gastrectomy by reviewing and summarizing recently published clinical trials.

RECENT FINDINGS: Surgery remains the most effective therapy for obese patients meeting criteria. Excess weight loss in short-term follow-up appears similar between RYGB and sleeve gastrectomy. Long-term data on sleeve gastrectomy are limited. RYGB is more effective in producing resolution and remission of type II diabetes mellitus, particularly in patients at high risk for relapse. RYGB and sleeve gastrectomy are similar in their reduction of other obesity-related comorbid conditions with the exception of gastroesophageal reflux disease. RYGB has slightly higher overall morbidity but mortality is similar.

SUMMARY: RYGB and sleeve gastrectomy are well tolerated and effective bariatric operations and represent metabolic surgery. More prospective, long-term data are needed. Both procedures benefit specific groups of patients better than the other. Research defining the obese patient's metabolic state and the metabolic response to both operations will ultimately allow physicians to optimally match patient and procedure.