Long-Term Outcomes and Predictors of Recurrent Weight Gain After Sleeve Gastrectomy, Roux-En-Y Gastric Bypass, and One Anastomosis Gastric Bypass: Turkish Metabolic and Bariatric Surgery Follow-up Study (TMBS Study).
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Kiyici Sinem, Koca Nizameddin, Sahin Alak Zehra Yagmur, Uzgec Guller Pinar, Sigirli Deniz, Çeler Özgen, Yılmaz Yaşar Hamiyet, Or Koca Arzu, Buluş Hakan, Fenkci Semin Melahat, Ugur Kader, Aygen Erhan, Ebiloglu Mehmet Fatih, Cander Soner, Ersoy Canan, Yıldız Saliha, Kızıltan Remzi, Gogas Yavuz Dilek, Yalcin Kehribar Demet, Akkurt Kocaeli Ayşen, Gelir Çavdar Gamze, Sumbul Hilmi Erdem, Mercantepe Filiz, Kalcan Süleyman, Uysal Serhat, Sariakcali Baris, Sari Ramazan, Kutluturk Faruk, Elbüken Gülşah, Akkuş Gamze, Yalav Orcun, Uyar Seyit, Baldane Süleyman, Tamer Gonca, Cakir Ilkay, Mert Meral, Seyit Hakan, Mete Turkan, Calikoglu Fulya, Soyluk Selcukbiricik Ozlem, Kubat Üzüm Ayşe, İzol Torun Ayşe Nur, Pekkolay Zafer, Haymana Cem, Yuksel Guler Bagdagul, Bayraktaroglu Taner, Topaloglu Ömercan, Şahin İbrahim, Turhan İyidir Özlem, Çiftel Serpil, Akhanlı Pınar, Kartal Baykan Emine, Yıldırım Şimşir Ilgın, Yalcin Mehmet Muhittin, Yazici Dilek, Mızrak Mithat, Mercan Sarıdaş Filiz, Ateş Coşkun, Kocaman Banu Betül, Capar Emre, Çatak Merve, Aksoydan Zubaroglu Ulcaz Perihan, Çelik Murat, Uslu Neslihan, Karslı Seda, Mısıroglu Fuat, Yigit Mehmet, Yunusov Eldeniz, Sehit Kara Canan, Yumuk Volkan Demirhan, Bayram Fahri, Sönmez Alper
Аннотация
METHODS: This nationwide, multicenter, retrospective cohort study (n = 1,498; 78.8% women; 37 centers) used stratified random sampling. Primary outcomes were %TWL and RWG (≥ 10% of total weight lost from nadir and sensitivity analysis used the IFSO 2024 threshold of > 30%). Multivariable regression and propensity score matching (PSM) addressed baseline imbalances.
RESULTS: Procedures included Sleeve Gastrectomy (SG, n = 1,321), Roux-en-Y Gastric Bypass (RYGB, n = 124), and One Anastomosis Gastric Bypass (OAGB, n = 53). Median follow-up: SG 66 [IQR 35-91], RYGB 55 [34-98], OAGB 53 [25-100] months (p = 0.704). Nadir %TWL was comparable (~ 38%, p = 0.683). At last follow-up, median %TWL differed significantly (OAGB 33.6%, RYGB 31.7%, SG 29.6%; p = 0.010). OAGB was independently associated with lower RWG than SG (OR 0.34, 95% CI 0.18-0.64; p < 0.001), and this association was confirmed in the PSM cohort (OAGB vs SG: RWG, 37.7% vs 61.6%; p = 0.004; %TWL, 33.8% vs 30.2%; p = 0.046). Metabolic and renal parameters differed across procedure groups, but standardized remission or relapse endpoints were not assessed.
CONCLUSION: In this Turkish multicenter retrospective cohort with long-term follow-up, OAGB was associated with greater current %TWL and lower RWG compared with SG, while RYGB showed intermediate weight outcomes. Given the small OAGB subgroup, confirmation in larger prospective studies is warranted.
KEY POINTS: Short-term weight loss was similar across SG, RYGB, and OAGB. RYGB and OAGB were associated with more favorable long-term weight loss than SG. OAGB was associated with a lower RWG than SG in this cohort (absolute risk difference -20.1%; NNT=4.9), but larger prospective studies with standardized follow-up are needed.