BS O01 - Comparison of Roux-en-Y Gastric Bypass(RYGBP) and Laparoscopic Sleeve Gastrectomy(LSG) in patients with obesity and diabetes mellitus: Meta-analysis and systemic review

Abstract Background Laparoscopic Sleeve gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) are the two procedures used to treat patients with obesity and type 2 diabetes mellitus(T2DM). However, it is still unclear which of the two procedures is better for T2DM remission. This study aims to compare the effectiveness of LSG and RYGB considering important comparison outcomes including diabetes remission, and overall glycemic and metabolic control. Method We conducted a comprehensive search of Medline, PubMed, the Cochrane Library, Scopus, the Web of Science, Clinical Key, Ovid, and Wiley from their inceptions through August 2022 for randomized controlled trials (RCTs) comparing LSG with RYGB for patients with morbid obesity and T2DM. The data were extracted and pooled using Review Manager software (RevMan5.4). Results Eighteen RCTs including 1360 patients were found. After one year, two years, and five years, the RYGB group's BMI was significantly lower than the LSG group's as follows respectively (MD = -1.58, P < 0.0001), (MD = -1.64, P=0.03), and (MD = -2.26, P= 0.0004). Moreover, the LSG group had a higher incidence of diabetes remission than the RYGP group after five years. Although there was no significant difference in terms of safety outcomes between both groups, GERD was significantly higher in the LSG group, and dumping syndrome was significantly higher in the RYGB group. Conclusion RYGB is more effective in achieving weight loss and reducing BMI, while LSG shows better improvement in diabetes remission, notably for those with high BMI. Both surgeries have similar complication rates, but RYGB has a higher incidence of dumping syndrome and lower rates of GERD compared to LSG.