Comparison of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass: Which Procedure is More Effective? A Systematic Review

• DOI: https://doi.org/10.22533/at.ed.1594982408114

• Palavras-chave: “Laparoscopic Sleeve Gastrectomy”, ‘Laparoscopic Roux-en-Y Gastric Bypass’, ‘bariatric surgery’, ‘weight loss’, ‘results of surgery for obesity’, and ‘resolution of comorbidities’.

• Keywords: “Laparoscopic Sleeve Gastrectomy”, ‘Laparoscopic Roux-en-Y Gastric Bypass’, ‘bariatric surgery’, ‘weight loss’, ‘results of surgery for obesity’, and ‘resolution of comorbidities’.

• Abstract:

  INTRODUCTION: Obesity, with its high prevalence and impact on comorbidities such as type 2 diabetes and hypertension, is a serious public health problem that also generates significant social and economic costs. Among treatment approaches, bariatric surgeries such as Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) stand out. LSG reduces stomach volume, while LRYGB combines restriction and malabsorption. Comparing these procedures is essential to evaluate differences in efficacy, risks and complications, guiding evidence-based clinical choices for better outcomes. OBJECTIVE: The aim of this review is to compare the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on weight loss, glycemic control, management of comorbidities, postoperative complications and impact on quality of life in patients with obesity. METHODS: The search was carried out in the PUBMED, VHL and MEDLINE databases, covering articles in English from 2019 to 2024, using keywords related to LSG and LRYGB. Initially, 512 articles were identified, of which 150 were selected after screening for duplicates and non-comparative articles. In the end, 37 studies were included in the analysis after a full review. RESULTS AND DISCUSSION:Laparoscopic Sleeve Gastrectomy (LSG) involves removing 75% of the stomach, forming a narrow tube that limits food intake. This reduces the secretion of ghrelin, the "hunger hormone", promoting satiety and reducing calorie intake. In addition, LSG increases the release of peptide YY (PYY) and GLP-1, hormones that promote satiety and improve insulin sensitivity. Roux-en-Y gastric bypass (RYLGB) combines restriction and malabsorption, resulting in more pronounced weight loss in the long term. It reduces the absorption of calories and nutrients, increasing the secretion of GLP-1 and PYY more intensely than LSG. This contributes to better control of comorbidities such as type 2 diabetes. LSG is less invasive, has a lower risk of nutritional complications and allows for faster recovery. However, initial weight loss may be lower than with RYGB, which, despite requiring strict nutritional monitoring, tends to result in more sustained weight loss. Both surgeries are effective in reducing comorbidities such as type 2 diabetes, hypertension and dyslipidemia. LSG provides rapid weight loss that improves insulin sensitivity, while RYGB is more effective in reducing carbohydrate absorption. In terms of quality of life, LSG allows for a faster recovery and lower risk of complications, while RYGB can have a negative impact due to possible nutritional deficiencies. LSG and RYGB have short- and long-term complications. In the short term, these include infections and leaks, while in the long term, LSG can lead to stenosis, gastroesophageal reflux and nutritional deficiencies. RYGB also carries risks of nutritional complications and requires constant monitoring. CONCLUSION: The comparison between Laparoscopic Sleeve Gastrectomy (LSG) and Roux-en-Y Gastric Bypass (RYGB) shows that both are effective in the treatment of morbid obesity, but have distinct characteristics that influence weight loss and quality of life. LSG is simpler and has a faster recovery, but can face challenges in maintaining weight loss over the long term. In contrast, RYGB provides more significant and lasting weight loss, with additional benefits for comorbidities, but requires strict nutritional monitoring. The choice between procedures should be patient-centered, taking into account the patient's needs, expectations and the importance of dietary re-education. Success depends on collaboration between doctor and patient, with continuous post-operative follow-up aimed at reducing dissatisfaction and promoting better health outcomes and quality of life.
  "Laparoscopic Sleeve Gastrectomy", "Laparoscopic Roux-en-Y Gastric Bypass", "bariatric surgery", "weight loss", "results of surgery for obesity", and "resolution of comorbidities".