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Abstract
Background:
Obesity is a significant global health concern and is very common in the United Arab Emirates (UAE), where it is among the leading causes of metabolic diseases like type 2 diabetes mellitus, hypertension, and dyslipidemia. The most common long-term weight management surgery is bariatric surgery, especially the sleeve gastrectomy (SG) and the Roux-en-Y gastric bypass (RYGB). Nonetheless, there is little comparative evidence on their effectiveness and applicability in the long term and in the UAE population.
Objectives:
The purpose of the study was to review and meta-analyze the long-term outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass as weight loss and metabolic outcomes with an emphasis on their applicability to the UAE population.
Methods:
In line with the PRISMA 2020 guidelines, a systematic literature search was performed in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Original studies that directly compared SG and RYGB were used (full-text). There were 2,987 records found, 842 of which were duplicates. After sifting through 2,145 titles and abstracts, 63 full-text articles were evaluated to determine their eligibility. Nine studies were included that met the inclusion criteria, five of which were included in the quantitative meta-analysis and four studies in the qualitative synthesis. The continuous outcomes were combined into standardized mean differences (SMDs) and dichotomous outcomes into odds ratios (ORs) applying a random-effects model with 95% confidence intervals.
Results:
There were 1,842 participants (SG = 1,012; RYGB = 830) in the quantitative analysis. At 5 years, RYGB demonstrated significantly greater weight loss compared to SG (SMD = 0.43; 95% CI: 0.18–0.69; I² = 0%), with sustained superiority at 10 years (SMD = 0.45; 95% CI: 0.16–0.73). No significant difference was observed at 1 year (SMD = 0.24; 95% CI: −0.04–0.51; I² = 31.5%). The 1-year pooled analysis revealed an odds ratio of 3.56 (95% CI: 0.23-54.75) with no significant differences at 5 and 10 years to achieve remission in type 2 diabetes. RYGB demonstrated significantly higher remission rates for hypertension at 5 years (OR = 2.47; 95% CI: 1.23–4.94) and 10 years (OR = 3.38; 95% CI: 1.24–9.26). Dyslipidemia remission was also higher with RYGB at 1 year (OR = 3.66; 95% CI: 2.03–6.59). The results were corroborated by qualitative data of the UAE and regional ones, which indicated the same patterns among the local population.
Conclusion:
Both SG and RYGB are effective bariatric surgeries to treat obesity and related metabolic disorders. Nevertheless, RYGB seems to yield more weight loss in the long term and improved hypertension and dyslipidemia. Type 2 diabetes remission did not show any long-term benefit. The results may be applicable to the population of the UAE, but more region-specific research is required to prove these results.