The most commonly performed bariatric procedures worldwide are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), yet outcomes following these procedures in young adults are limited. Therefore, the objective of this study was to compare weight loss outcomes between RYGB and SG in young adults.
This is a nationwide retrospective cohort study of young adults, aged 18–25 years, who underwent RYGB or SG between 2015 and 2019, with data from the Dutch Audit Treatment of Obesity (DATO). The primary outcome was weight loss expressed as percentage total weight loss (%TWL) in a period of 3 years after surgery. Secondary outcomes were the incidence of complications (< 30 days) and progression of obesity-related comorbidities.
In total, 2313 patients were included, 1246 in the RYGB group and 1067 in the SG group. Percentage TWL was significantly higher in the RYGB group compared to the SG group at 1, 2, and 3 years after surgery (respectively 2.4%, 2.9%, and 3.3% higher, p < 0.001). RYGB was associated with an on-average 2.75 higher %TWL compared to SG in females (p < 0.001), although this was not seen in males (β = 0.63, p = 0.514). No differences were found in the incidence of complications, nor the progression of obesity-related comorbidities except for gastroesophageal reflux disease (GERD). There was more improvement or resolution of GERD in the RYGB group (95.2% vs. 56.3%, p < 0.001).
Similar numbers of RYGB and SG were performed in young adults, whereas RYGB was associated with greater weight loss in the short- and midterm, particularly in females.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011;377(9765):557–67.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.
Beamish AJ, D’Alessio DA, Inge TH. Controversial Issues: when the drugs don’t work, can surgery provide a different outcome for diabetic adolescents? Surg Obes Relat Dis. 2015;11(4):946–8.
Shah AS, D’Alessio D, Ford-Adams ME, Desai AP, Inge TH. Bariatric surgery: a potential treatment for type 2 diabetes in youth. Diabetes Care. 2016;39(6):934–40.
Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity (Silver Spring). 2010;18(9):1801–4.
Bendor CD, Bardugo A, Pinhas-Hamiel O, Afek A, Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol. 2020;19(1):79.
Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.
Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol. 2017;5(3):174–83.
Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.
Lee Y, Doumouras AG, Yu J, Aditya I, Gmora S, Anvari M, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis of weight loss, comorbidities, and biochemical outcomes from randomized controlled trials. Ann Surg. 2021;273(1):66–74.
Poelemeijer YQM, Liem RSL, Nienhuijs SW. A Dutch nationwide bariatric quality registry: DATO. Obes Surg. 2018;28(6):1602–10.
Jaarrapportage 2019 DATO [Internet]. Dutch Institute for Clinical Auditing. 2019. Available from: https://dica.nl/jaarrapportage-2019/dato.
Major P, Wysocki M, Dworak J, Pędziwiatr M, Pisarska M, Wierdak M, et al. Analysis of laparoscopic sleeve gastrectomy learning curve and its influence on rocedure Safety and Perioperative Complications. Obes Surg. 2018;28(6):1672–80.
Salminen P, Helmiö M, Ovaska J, Juuti A, Leivonen M, Peromaa-Haavisto P, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319(3):241–54.
Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, 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. 2018;319(3):255–65.
McVay MA, Friedman KE, Applegate KL, Portenier DD. Patient predictors of follow-up care attendance in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis. 2013;9(6):956–62.
Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:Cd003641.
Jenkins TM, Xanthakos SA, Zeller MH, Barnett SJ, Inge TH. Distance to clinic and follow-up visit compliance in adolescent gastric bypass cohort. Surg Obes Relat Dis. 2011;7(5):611–5.
Cooiman MI, Aarts EO, Janssen IMC, Hazebroek EJ, Berends FJ. Weight loss, remission of comorbidities, and quality of life after bariatric surgery in young adult patients. Obes Surg. 2019;29(6):1851–7.
Romeijn MM, van Hoef S, Janssen L, van de Pas KGH, van Dielen FMH, Luijten AAPM, Göttgens KWA, Greve JWM, Leclercq WKG. Comparison of linear versus circular-stapled gastroenterostomy in Roux-en-Y gastric bypass: a nationwide population-based cohort study. Obes Surg. 2021;31(8):3579–87.
Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1):42–55.
Uittenbogaart M. A216 Defining an international standard for primary and secondary non-response following bariatric surgery for research purposes: a modified Delphi consensus. Surg Obes Relat Dis. 2019;15(10):76.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.
Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Dutch Audit for Treatment of Obesity Research Group. Marang-van de Mheen PJ Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis. 2021;17(7):1349–58.
Nielsen MS, Christensen BJ, Schmidt JB, Tækker L, Holm L, Lunn S, et al. Predictors of weight loss after bariatric surgery-a cross-disciplinary approach combining physiological, social, and psychological measures. Int J Obes (Lond). 2020;44(11):2291–302.
Poelemeijer YQM, Liem RSL, Våge V, Mala T, Sundbom M, Ottosson J, et al. Gastric bypass versus sleeve gastrectomy: patient selection and short-term outcome of 47,101 primary operations from the Swedish, Norwegian, and Dutch national quality registries. Ann Surg. 2020;272(2):326–33.
de Jong MMC, Hinnen C. Bariatric surgery in young adults: a multicenter study into weight loss, dietary adherence, and quality of life. Surg Obes Relat Dis. 2017;13(7):1204–10.
Dey M, Gmel G, Mohler-Kuo M. Body mass index and health-related quality of life among young Swiss men. BMC Public Health. 2013;13:1028.
Perrone F, Bianciardi E, Benavoli D, Tognoni V, Niolu C, Siracusano A, et al. Gender influence on long-term weight loss and comorbidities after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective study with a 5-year follow-up. Obes Surg. 2016;26(2):276–81.
Coleman KJ, Huang YC, Hendee F, Watson HL, Casillas RA, Brookey J. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10(3):396–403.
Ketterer C, Heni M, Stingl K, Tschritter O, Linder K, Wagner R, et al. Polymorphism rs3123554 in CNR2 reveals gender-specific effects on body weight and affects loss of body weight and cerebral insulin action. Obesity (Silver Spring). 2014;22(3):925–31.
Mocanu V, Lai K, Dang JT, Switzer NJ, Birch DW, Ball GDC, et al. Evaluation of the trends, characteristics, and outcomes in North American youth undergoing elective bariatric surgery. Obes Surg. 2021;31(5):2180–7.
Sebastianelli L, Benois M, Vanbiervliet G, Bailly L, Robert M, Turrin N, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29(5):1462–9.
Genco A, Soricelli E, Casella G, Maselli R, Castagneto-Gissey L, Di Lorenzo N, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.
Lazoura O, Zacharoulis D, Triantafyllidis G, Fanariotis M, Sioka E, Papamargaritis D, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg. 2011;21(3):295–9.
Luca P, Nicolas C, Marina V, Sarah B, Andrea L. Where are my patients? Lost and found in bariatric surgery. Obes Surg. 2021;31(5):1979–85.
The authors thank the members of the Dutch Institute for Clinical Auditing (DICA) for the registration of the data and for providing us with the data. The members of the Dutch Audit for Treatment of Obesity research group are co-authors of this study, and we want to thank them for their input.
Dutch Audit for Treatment of Obesity Research Group:
Dhr. dr. L.M. de Brauw, chirurg, Spaarne Gasthuis, Haarlem, the Netherlands
Dhr. dr. S.M.M. de Castro, chirurg, OLVG, Amsterdam, the Netherlands
Dhr. drs. S.L. Damen, chirurg, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
Dhr. dr. F.H.W. Jonker, chirurg, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands
Dhr. drs. J.A. Apers, chirurg, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
Dhr. dr. I.F. Faneyte, chirurg, Ziekenhuisgroep Twente, Almelo, the Netherlands
Dhr. prof. dr. J.W.M. Greve, chirurg, Zuyderland Medisch Centrum, Heerlen, the Netherlands
Dhr. prof. dr. E.J. Hazebroek, chirurg, Rijnstate, Arnhem, DSMBS, the Netherlands
Dhr. drs. G. van ’t Hof, chirurg, Bariatrisch Centrum Zuid-West Nederland, Bergen op Zoom, the Netherlands
Dhr. dr. I.M.C. Janssen, chirurg, Medisch Directeur Nederlandse Obesitas Klinieken, Zeist, the Netherlands
Dhr. drs. E.H. Jutte, chirurg, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
Dhr. drs. R.A. Klaassen, chirurg, Maasstad Ziekenhuis, Rotterdam, the Netherlands
Dhr. drs. E.A.G.L. Lagae, chirurg, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, the Netherlands
Mw. dr. B.S. Langenhoff, chirurg, ETZ, Tilburg, the Netherlands
Dhr. drs. R.S.L. Liem, chirurg, Groene Hart Ziekenhuis, secretary, Gouda, the Netherlands
Dhr. drs. A.A.P.M. Luijten, Máxima Medisch Centrum, Eindhoven, the Netherlands
Dhr. dr. S.W. Nienhuijs, chirurg, Catharina Ziekenhuis, chairman, Eindhoven, the Netherlands
Dhr. dr. R. Schouten, chirurg, Flevoziekenhuis, Almere, the Netherlands
Dhr. dr. R.M. Smeenk, chirurg, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
Dhr. dr. D.J. Swank, chirurg, Nederlandse Obesitas Kliniek West, Den Haag & Gouda, the Netherlands
Dhr. dr. M.J. Wiezer, chirurg, St. Antonius Ziekenhuis, Utrecht, the Netherlands
Dhr. drs. W. Vening, bariatrisch chirurg, Rijnstate, Arnhem, the Netherlands
All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Reporting to DATO in the Netherlands is mandatory. Informed consent does not apply according to Dutch law.
Conflict of Interest
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
- Similar numbers of RYGB and SG are performed in young adults.
- Bariatric surgery in young adults appears to be safe.
- RYGB is associated with greater weight loss, particularly in females.
About this article
Cite this article
van de Pas, K.G.H., Bonouvrie, D.S., Janssen, L. et al. Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy in Young Adults: a Dutch Registry Study. OBES SURG 32, 763–770 (2022). https://doi.org/10.1007/s11695-021-05846-4