Sleeve Gastrectomy With Jejunojejunal Bypass Versus Sleeve Gastrectomy: 12‐Month Outcomes From a Propensity Score–Matched Analysis

Sleeve gastrectomy is widely used to treat obesity, but inadequate weight loss or weight regain remains a clinical concern. Comparative evidence for sleeve gastrectomy with jejunojejunal bypass (SG-JJB) versus standard sleeve gastrectomy (SG) is limited. This single-centre retrospective cohort compared 12-month outcomes and examined bypass proportion in relation to weight loss. Among 191 propensity score-matched patients (126 SG; 65 SG-JJB), matching-weighted mean percentage total weight loss (%TWL) was 26.59% after SG and 30.16% after SG-JJB. The adjusted difference was 3.55 percentage points (95% CI, 0.36 to 6.74; p = 0.030). After multiplicity adjustment, no clear between-group differences were identified in glycemic, lipid, hepatic, or nutritional outcomes. Recorded complications and complaints were infrequent, limiting comparative safety inference. Among all 70 SG-JJB patients, restricted cubic spline analysis suggested a non-linear association between bypass proportion and %TWL (P for non-linearity = 0.044). The fitted curve peaked at a bypass proportion of 0.359, with predicted %TWL of 35.62% (pointwise 95% CI, 32.86% to 38.39%). This peak was within the observed 10th-to-90th percentile interval of 0.272 to 0.371, although bootstrap analyses indicated uncertainty in its location. In this matched cohort, SG-JJB was associated with greater 12-month weight loss than SG. Evidence for differences in metabolic, nutritional and safety-related outcomes remained inconclusive. The central observed bypass-proportion interval may inform prospective evaluation but not current operative selection.