Obesity Surgery

, Volume 24, Issue 10, pp 1617–1624 | Cite as

A Randomized Clinical Trial of Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy for the Treatment of Morbid Obesity in China: a 5-Year Outcome

  • Yong Zhang
  • Hongzhi Zhao
  • Zhanguo Cao
  • Xiangyu Sun
  • Chen Zhang
  • Wang Cai
  • Rong Liu
  • Sanyuan Hu
  • Mingfang Qin
Original Contributions



No randomized comparative trials have presented long-term outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study was designed to compare the efficacy and safety of these two procedures.


From January 2007 to July 2008, 64 eligible patients were randomly assigned to LSG or LRYGB. During the 5-year follow-up, we compared morbidity rate, body mass index (BMI), percent of excess weight loss (%EWL), Moorehead-Ardelt (M-A) II quality of life, and resolution or improvement rate of obesity-related comorbidities between the groups.


Both groups were matched with respect to age, gender, and BMI. Slightly more major complications were observed in patients undergoing LRYGB (P > 0.05). Weight loss was significantly better with LRYGB except during the first postoperative year. At 5 years, %EWL for LSG and LRYGB was 63.2 ± 24.5 % and 76.2 ± 21.7 % (P = 0.02), respectively. No statistical difference was observed in quality of life between the groups at all intervals (P > 0.05). At the last follow-up, most comorbidities in both groups were resolved or improved, with no difference between the groups (P > 0.05).


LRYGB and LSG are equally safe and effective in quality of life and improvement or resolution of comorbidities, and LRYGB possesses the superiority in terms of weight loss. Further studies are needed to evaluate micronutrient deficiencies of these procedures.


Bariatric surgery Laparoscopy Sleeve gastrectomy Gastric bypass Quality of life 


Conflict of Interest

The authors declare that they have no conflict of interest with the materials presented here.


  1. 1.
    Li X, Zheng C, Rosenthal RJ. The new concept of bariatric surgery in China–reevaluation of surgical indications and criteria of therapeutic effect of laparoscopy for treatment of obesity. Obes Surg. 2008;18(9):1180–2.PubMedCrossRefGoogle Scholar
  2. 2.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic Gastric Bypass, Roux-en-Y: Preliminary Report of Five Cases. Obes Surg. 1994;4(4):353–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Edholm D, Svensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2012.Google Scholar
  4. 4.
    Himpens J, Verbrugghe A, Cadiere GB, et al. Long-term results of laparoscopic Roux-en-Y Gastric bypass: evaluation after 9 years. Obes Surg. 2012;22(10):1586–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Attiah MA, Halpern CH, Balmuri U, et al. Durability of Roux-en-Y gastric bypass surgery: a meta-regression study. Ann Surg. 2012;256(2):251–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Regan JP, Inabnet WB, Gagner M, et al. Early experience with 2-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis. 2013;9(1):21–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Abbatini F, Capoccia D, Casella G, et al. Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(4):498–502.PubMedCrossRefGoogle Scholar
  10. 10.
    Moorehead MK, Ardelt-Gattinger E, Lechner H, et al. The validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obes Surg. 2003;13(5):684–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Peterli R, Borbely Y, Kern B, et al. Early Results of the Swiss Multicentre Bypass Or Sleeve Study (SM-BOSS): A Prospective Randomized Trial Comparing Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Ann Surg. 2013.Google Scholar
  12. 12.
    Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Prasad P, Tantia O, Patle N, et al. An analysis of 1-3-year follow-up results of laparoscopic sleeve gastrectomy: an Indian perspective. ObesSurg. 2012;22(3):507–14.Google Scholar
  14. 14.
    Gill RS, Switzer N, Driedger M, et al. Laparoscopic sleeve gastrectomy with staple line buttress reinforcement in 116 consecutive morbidly obese patients. Obes Surg. 2012;22(4):560–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Carlin AM, Zeni TM, English WJ, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg. 2013;257(5):791–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Mohos E, Schmaldienst E, Prager M. Quality of life parameters, weight change and improvement of co-morbidities after laparoscopic Roux Y gastric bypass and laparoscopic gastric sleeve resection–comparative study. Obes Surg. 2011;21(3):288–94.PubMedCrossRefGoogle Scholar
  17. 17.
    Yang X, Yang G, Wang W, et al. A meta-analysis: to compare the clinical results between gastric bypass and sleeve gastrectomy for the obese patients. Obes Surg. 2013;23(7):1001–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Lim DM, Taller J, Bertucci W, et al. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution. Surg Obes Relat Dis. 2012.Google Scholar
  19. 19.
    Leyba JL, Aulestia SN, Llopis SN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients. Obes Surg. 2011;21(2):212–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Vidal P, Ramon JM, Goday A, et al. Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results Obes Surg. 2013;23(3):292–9.CrossRefGoogle Scholar
  21. 21.
    Chouillard EK, Karaa A, Elkhoury M, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case–control study. Surg Obes Relat Dis. 2011;7(4):500–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Boza C, Gamboa C, Salinas J, et al. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: a case–control study and 3 years of follow-up. Surg Obes Relat Dis. 2012;8(3):243–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010;20(1):1–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Lee WJ, Chen CY, Chong K, et al. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):683–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9(5):616–29.CrossRefGoogle Scholar
  26. 26.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31(8):1248–61.CrossRefGoogle Scholar
  28. 28.
    Muller MK, Wenger C, Schiesser M, et al. Quality of life after bariatric surgery–a comparative study of laparoscopic banding vs. bypass. Obes Surg. 2008;18(12):1551–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The ObesitySociety, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;Suppl 1:S1-27.Google Scholar
  31. 31.
    Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg. 2010;20(4):447–53.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Yong Zhang
    • 1
    • 2
  • Hongzhi Zhao
    • 1
  • Zhanguo Cao
    • 1
  • Xiangyu Sun
    • 1
  • Chen Zhang
    • 1
  • Wang Cai
    • 1
  • Rong Liu
    • 3
  • Sanyuan Hu
    • 4
  • Mingfang Qin
    • 1
  1. 1.Center of Minimally Invasive SurgeryNankai Hospital of Tianjin Medical UniversityTianjinChina
  2. 2.Gastrointestinal surgeryInner Mongolia People’s HospitalHohhotChina
  3. 3.Chinese PLA General HospitalBeijingChina
  4. 4.Qilu Hospital of Shandong UniversityJinanChina

Personalised recommendations