Evaluating the Effectiveness and Long-term Outcomes of Roux-en-Y Gastric Bypass vs Gastric Sleeve Bariatric Surgery in Obese and Diabetic Patients: Systematic Review
Bibliographic record
Abstract
BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are significant contributors to global morbidity, mortality, and rising healthcare costs. Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), has emerged as highly effective interventions for weight loss and metabolic control. However, long-term comparative data on sustained weight loss, T2DM remission, and postoperative complications remain inconsistent. STUDY DESIGN: This systematic review compares long-term outcomes of RYGB and SG in patients with obesity and T2DM, emphasizing sustained weight loss, T2DM remission, revisional surgery, and postoperative complications, including gastroesophageal reflux disease (GERD), Barrett's esophagus, and anastomotic leak. A systematic search of PubMed and ScienceDirect identified randomized controlled trials and observational cohort studies from 2005 to 2024. Eligible studies had five years or more of follow-up and assessed weight loss, T2DM remission, GERD, and revisional rates in adults undergoing RYGB or SG. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. RESULTS: RYGB was associated with more significant long-term weight loss and superior T2DM remission rates. SG had a lower risk of nutritional deficiencies with increased risk of complications requiring surgical revision, particularly GERD, which may progress to Barrett's esophagus and increase esophageal cancer risk. Revisional surgery occurs frequently post-SG surgery due to weight recurrence and treatment-resistant GERD. In contrast, RYGB revisions were more often due to marginal ulcers and strictures. CONCLUSIONS: RYGB and SG procedures stand out as effective bariatric surgical choices for treating obesity and T2DM. RYGB produces superior weight loss and metabolic outcomes, while SG presents a safer overall profile. Surgical selection process should be individualized based on comorbidities, T2DM duration, and ongoing postoperative monitoring needs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".