Effects of sleeve gastrectomy versus omega-loop gastric bypass. What is best for weight loss, perioperative adverse events, and comorbidities?

Aim of the study: This study investigated whether Sleeve Gastrectomy (SG) or Omega-Loop-Gastric-Bypass (OAGB) has the best benefit in weight loss, perioperative risk, and remission of comorbidities. Methods: 29,407 patients after SG and OAGB were included in the German Bariatric Surgery Registry (GBSR). Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after one year of follow-up. Results: 15,169 patients had completed 1-year follow-up (770 patients after OAGB and 14,399 after SG). The %EWL was higher for OAGB than for SG (70.4 ± 18.5 for OAGB and 62.4 ± 22.6 for SG; p<0.001). BMI reduction was also a significant difference in favor of OAGB (17.5 ± 5.6 kg/m2 for OAGB vs. 15.5 ± 5.9 for SG; p<0.001). There was no significant difference between the two groups in perioperative complications (p<5%). Significant differences in favor of OAGB were found in remission of hypertension (p<0.001), IDDM (p<0.001), NIDDM (p<0.001), reflux (p<0.001), and sleep apnea (p<0.001). Conclusion: Our analysis showed that OAGB surgery was associated with more significant BMI reduction and weight loss one year after surgery. In addition, OAGB surgery was significantly more effective in improving obesity-related comorbidities. Our results support the performance of OAGB over SG in patients with obesity and comorbidities. However, the contraindications and general condition of the patient should be considered in the context of this.