Laparoscopic Roux-En-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Weight Loss, Type 2 Diabetes and Comorbidities

More and more U.S. citizens are obese, and many U.S. citizens have been diagnosed with type 2 diabetes. In general, bariatric surgery is used to treat obesity. However, some forms of bariatric surgery can lead to type 2 diabetes remission. Two types of bariatric surgical methods in use for weight loss are laparoscopic roux-en-y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). These two surgical methods are often considered to be treatment options for type 2 diabetes. And while LRYGB may be the most effective treatment for weight loss, a recent study indicates that LSG is as effective as LRYGB for type 2 diabetes treatment.

LRYGB and LSG are similar in some ways: For example, both surgeries "modify the upper gastrointestinal tract anatomy." And this characteristic may make LRYGB and LSG more effective at weight loss and type 2 diabetes management than some other forms of bariatric surgery. However, depending on the disease condition, there are differences in the outcomes associated with the two surgical methods.

The study, mentioned above, showed that both LRYGB and LSG were equally effective in type 2 diabetes remission, obstructive sleep apnoea and quality of life (QoL) improvement. However, LRYGB produced better remission in hypertension, but was associated with a higher complication rate.

Specifically, the researchers concluded that "Although LRYGB induced greater weight loss and better amelioration  of hypertension than LSG, there was no difference in remission of T2DM,  obstructive sleep apnoea, or QoL at 5 years. There were more complications after  LRYGB, but the individual burden for patients with complications was similar  after both operations."

It is also important to remember that there may be contraindications and other potential issues to consider when deciding on the appropriate form of bariatric surgery. The possibility of reintervention should be kept in mind, for example. Indeed, one study demonstrated that "[LSG] has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up."

So, depending on the desired treatment outcome, the healthcare provider and the patient should work together to make the appropriate decision when it comes to bariatric surgery. 

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