Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity: The SM-BOSS Randomized Clinical Trial.

Summary

In this multicenter RCT (n=217) with >10 years of follow-up, RYGB achieved higher excess BMI loss than sleeve gastrectomy in per-protocol analyses and was associated with fewer de novo GERD events and markedly fewer conversions. Intention-to-treat differences in %EBMIL were not significant, and total weight loss was similar between groups.

Key Findings

• Per-protocol %EBMIL at ≥10 years favored RYGB over SG (65.9% vs 56.1%; P=0.048).
• SG had higher conversion rates due to insufficient weight loss or reflux (29.9% vs 5.5%; P<.001).
• De novo GERD occurred more often after SG than RYGB (P=.02), while total weight loss was similar (27.7% vs 25.5%; P=.37).

Clinical Implications

For patients prioritizing reflux control and durability, RYGB may be preferred; SG candidates should be counseled on higher risks of de novo GERD and conversion over time.

Limitations

• Incomplete 10-year follow-up (65.4%) may introduce attrition bias
• Primary ITT comparison of %EBMIL at long-term was not statistically significant

Future Directions

Head-to-head trials stratifying by GERD status, diabetes remission durability, and nutritional outcomes, with standardized reflux metrics and patient-reported outcomes.