Background

Roux-en-Y gastric bypass (RYGB) has largely been supplanted by vertical sleeve gastrectomy (VSG) as the most commonly performed metabolic and bariatric surgery procedure for adults and adolescents. Data from adults demonstrate differences between the procedures regarding weight loss durability, comorbidity resolution, and safety profile, while outcomes in adolescents are limited and the long-term implications are unknown.

Methods

We compared 10-year outcomes following RYGB (n=161) and VSG (n=99) in a cohort of adolescents who underwent surgery from 2007 through 2012. BMI change, obesity-related comorbidity response, including micronutrient outcomes were examined using propensity score adjusted, linear mixed and Poisson mixed models.

Results

BMI change was similar between RYGB (-20%) and VSG (-18%) at 10 years (p=0.85). Both procedures had high rates of resolution in type 2 diabetes (RYGB=60%; VSG=47%), hypertension (RYGB=62%; VSG=49%), and dyslipidemia (RYGB=65%; VSG=50%) at 10 years. Participants who underwent VSG were less likely to experience resolution of type 2 diabetes (Risk Ratio[RR]: 0.76[0.57,1.02], p=0.07), hypertension (RR: 0.84[0.71,0.98], p=0.03), and dyslipidemia (RR: 0.76[0.63,0.93], p<0.01) compared to those who underwent RYGB. VSG was also less commonly associated with postoperative micronutrient deficiencies: low ferritin (RR: 0.57[0.44,0.73], p<0.01) and low vitamin B12 (RR: 0.41[0.22,0.77], p<0.01) compared to RYGB. During post-operative years 4-10, anemia was less prevalent in those who underwent VSG compared to RYGB (prevalence risk: 0.36[0.25, 0.52], p<0.01).

Conclusions

Both RYGB and VSG were associated with long-term weight loss and co-morbidity resolution benefits. RYGB provided greater reduction of cardiometabolic complications of obesity, while VSG resulted in a more favorable micronutrient outcomes.