Keywords
Gastrectomia Vertical
Cirurgia Bariátrica
How to Cite
Abstract
Introduction: Obesity is a chronic condition associated with several metabolic comorbidities, such as type 2 diabetes, dyslipidemia, and hypertension. Bariatric surgeries have proven effective in controlling weight and associated metabolic complications. Among the most commonly used procedures are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), which differ in technique, complication profile, and metabolic outcomes.
Objective: To compare RYGB and SG in the treatment of obesity, focusing on safety, weight loss efficacy, metabolic impact, and incidence of postoperative complications.
Methodology: This review included randomized clinical trials and prospective studies published between 2014 and 2025. Comparisons covered weight loss, glycemic control, lipid profile, immediate and late postoperative complications, nutritional deficiencies, and control of obesity-associated comorbidities.
Conclusion: Both procedures demonstrated similar efficacy in weight loss up to five years of follow-up. RYGB proved superior in glycemic control, type 2 diabetes remission, and lipid profile improvement, in addition to being more effective in controlling gastroesophageal reflux. On the other hand, SG resulted in shorter surgical time, a lower rate of serious complications in the immediate postoperative period, and a lower incidence of nutritional deficiencies, although it was associated with a higher incidence of reflux. RYGB had a higher incidence of early complications and bone density loss. The choice between techniques should be individualized, considering the patient's clinical and metabolic profile, with multidisciplinary monitoring essential to optimize results and minimize risks.
References
AXELROD, Christopher L.; HARI, Adithya; DANTAS, Wagner S.; KASHYAP, Sangeeta R.; SCHAUER, Philip R.; KIRWAN, John P. Metabolomic fingerprints of medical therapy versus bariatric surgery in patients with obesity and type 2 diabetes: the STAMPEDE trial. Diabetes Care, [S.l.], v. 47, n. 11, p. 2024–2032, nov. 2024. DOI: 10.2337/dc24-0859. PMID: 39311919.
BARSTAD, Lisa H.; JOHNSON, Line K.; BORGERAAS, Heidi; HOFSØ, Dag; SVANEVIK, Marius; SMÅSTUEN, Milada C.; HERTEL, Jens K.; HJELMESÆTH, Jøran. Changes in dietary intake, food tolerance, hedonic hunger, binge eating problems, and gastrointestinal symptoms after sleeve gastrectomy compared with after gastric bypass; 1-year results from the Oseberg study—a randomized controlled trial. American Journal of Clinical Nutrition, [S.l.], v. 117, n. 3, p. 586–598, mar. 2023. DOI: 10.1016/j.ajcnut.2022.11.016. PMID: 36811476.
BENAIGES, David; GODAY, Albert; CASAJOANA, Anna; FLORES‑LE ROUX, Juana A.; FITÓ, Montserrat; POZO, Óscar J.; SERRA, Carme; PERA, Manuel; LLAURADÓ, Gemma; CLIMENT, Elisenda; VILLATORO, Montserrat; LAZARO, Iolanda; CASTAÑER, Olga; PEDRO‑BOTET, Juan. Short‑term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial. Cardiovascular Diabetology, [S.l.], v. 23, n. 1, p. 205, 15 jun. 2024. DOI: 10.1186/s12933‑024‑02296‑x. PMID: 38879559.
BERNARD, Arnaud; LE BEYEC-LE BIHAN, Johanne; RADOI, Loredana; COUPAYE, Muriel; SAMI, Ouidad; CASANOVA, Nathalie; LE MAY, Cédric; COLLET, Xavier; DELABY, Pascaline; LE BOURGOT, Cindy; BESNARD, Philippe; LEDOUX, Séverine. Orosensory perception of fat/sweet stimuli and appetite-regulating peptides before and after sleeve gastrectomy or gastric bypass in adult women with obesity. Nutrients, [S.l.], v. 13, n. 3, p. 878, 8 mar. 2021. DOI: 10.3390/nu13030878. PMID: 33800516.
BY‑BAND‑SLEEVE COLLABORATIVE GROUP. Roux‑en‑Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By‑Band‑Sleeve): a multicentre, open label, three‑group, randomised controlled trial. The Lancet Diabetes & Endocrinology, [S.l.], v. 13, n. 5, p. 410–426, maio 2025. DOI: 10.1016/S2213‑8587(25)00025‑7. PMID: 40179925.
CATHELINE, J.-M.; FYSEKIDIS, M.; BENDACHA, Y.; PORTAL, J.-J.; HUTEN, N.; CHOUILLARD, E.; GUGENHEIM, J.; FOURTANIER, G.; ARAPIS, K.; MSIKA, S.; FABRE, J. M.; SODJI, M.; VICAUT, E.; DBOUK, R.; ROUSSEL, J.; COHEN, R. Prospective, multicentric, comparative study between sleeve gastrectomy and Roux-en-Y gastric bypass, 277 patients, 3 years follow-up. Journal of Visceral Surgery, [S.l.], v. 156, n. 6, p. 497–506, dez. 2019. DOI: 10.1016/j.jviscsurg.2019.04.013. PMID: 31103560.
HEDBERG, Suzanne; THORELL, Anders; ÖSTERBERG, Johanna; PELTONEN, Markku; ANDERSSON, Ellen; NÄSLUND, Erik; HERTEL, Jens Kristoffer; SVANEVIK, Marius; STENBERG, Erik; NEOVIUS, Martin; NÄSLUND, Ingmar; WIRÉN, Mikael; OTTOSSON, Johan; OLBERS, Torsten. Comparison of sleeve gastrectomy vs Roux-en-Y gastric bypass: a randomized clinical trial. JAMA Network Open, [S.l.], v. 7, n. 1, p. e2353141, 2 jan. 2024. DOI: 10.1001/jamanetworkopen.2023.53141. PMID: 38289603.
HOFSØ, Dag; HILLESTAD, Thor Olav Widerøe; HALVORSEN, Erling; FATIMA, Farhat; JOHNSON, Line Kristin; LINDBERG, Morten; SVANEVIK, Marius; SANDBU, Rune; HJELMESÆTH, Jøran. Bone mineral density and turnover after sleeve gastrectomy and gastric bypass: a randomized controlled trial (Oseberg). The Journal of Clinical Endocrinology & Metabolism, [S.l.], v. 106, n. 2, p. 501–511, jan. 2021. DOI: 10.1210/clinem/dgaa808. PMID: 33150385.
MEDEIROS, Veronica Garcia de; PAJECKI, Denis; DIAS, Maria Carolina Gonçalves; DANTAS, Anna Carolina Batista; CLEVA, Roberto de; SANTO, Marco Aurelio. Food tolerance and nutritional risk after sleeve gastrectomy and Roux-en-Y gastric bypass in elderly patients with severe obesity: a prospective, randomized controlled trial. Arquivos de Gastroenterologia, [S.l.], v. 59, n. 3, p. 370–374, jul./set. 2022. DOI: 10.1590/S0004-2803.202203000-67. PMID: 36102434.
MURPHY, Rinki; PLANK, Lindsay D.; CLARKE, Michael G.; EVENNETT, Nicholas J.; TAN, James; KIM, David D. W.; CUTFIELD, Richard; BOOTH, Michael W. C. Effect of banded Roux-en-Y gastric bypass versus sleeve gastrectomy on diabetes remission at 5 years among patients with obesity and type 2 diabetes: a blinded randomized clinical trial. Diabetes Care, [S.l.], v. 45, n. 7, p. 1503–1511, 7 jul. 2022. DOI: 10.2337/dc21-2498. PMID: 35554515.
NUSSBAUMER, Rahel; MEYER-GERSPACH, Anne Christin; PETERLI, Ralph; PETERS, Thomas; BEGLINGER, Christoph; CHIAPPETTA, Sonja; DREWE, Juergen; WÖLNERHANSSEN, Bettina. First-phase insulin and amylin after bariatric surgery: a prospective randomized trial on patients with insulin resistance or diabetes after gastric bypass or sleeve gastrectomy. Obesity Facts, [S.l.], v. 13, n. 6, p. 584–595, 2020. DOI: 10.1159/000511928. PMID: 33202416.
PAJECKI, Denis; PINHEIRO, Moisés Carmo Dos Anjos; DANTAS, Anna Carolina Batista; CORSI, Giovanna Cavanha; DIAS, Maria Carolina Gonçalves; SANTO, Marco Aurelio. Sleeve gastrectomy versus Roux‑en‑Y gastric bypass for treating obesity in patients > 65 years old: 3‑year outcomes of a randomized trial. Journal of Gastrointestinal Surgery, [S.l.], v. 27, n. 4, p. 780–782, abr. 2023. DOI: 10.1007/s11605-023-05608-w. PMID: 36717470.
PETERLI, R. et al. 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. JAMA, v. 319, n. 3, p. 255–265, 16 jan. 2018. PMID: 29340679
SAARINEN, Ilmari; STRANDBERG, Marjatta; HURME, Saija; GRÖNROOS, Sofia; JUUTI, Anne; HELMIÖ, Mika; SALMINEN, Paulina. Association of high-sensitivity C-reactive protein (hs-CRP) with weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass at 10 years: a secondary analysis of the SLEEVEPASS randomized clinical trial. Obesity Surgery, [S.l.], v. 34, n. 12, p. 4378–4384, dez. 2024. DOI: 10.1007/s11695-024-07567-w. PMID: 39509008.
SALMINEN, P. et al. Laparoscopic sleeve gastrectomy vs roux‑en‑y gastric bypass in adult patients with obesity: the SLEEVEPASS randomized clinical trial. JAMA Surgery, v. 157, n. 8, p. 656–666, ago. 2022. PMID: 35731535
WALLENIUS, Ville; DIRINCK, Eveline; FÄNDRIKS, Lars; MALECKAS, Almantas; LE ROUX, Carel W.; THORELL, Anders. Glycemic control after sleeve gastrectomy and Roux-en-Y gastric bypass in obese subjects with type 2 diabetes mellitus. Obesity Surgery, [S.l.], v. 28, n. 6, p. 1461–1472, jun. 2018. DOI: 10.1007/s11695-017-3061-3. PMID: 29264780.
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