American Diabetes Association
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Long-term survival after sleeve gastrectomy versus gastric bypass in a bi-national cohort study

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posted on 2022-07-07, 12:51 authored by Dag Holmberg, Giola Santoni, Joonas H. Kauppila, Sheraz Markar, Jesper Lagergren


Objective: Bariatric surgery prolongs life expectancy in severely obese individuals, but it is uncertain which of the two dominating bariatric procedures, sleeve gastrectomy or gastric bypass, offers the best long-term survival.

Research Design and Methods: This was a population-based cohort study comparing primary laparoscopic sleeve gastrectomy to gastric bypass for obesity in Sweden and Finland between January 1, 2007 and December 31, 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country, and calendar year.

Results: Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared to patients who underwent gastric bypass (n=51,891, 84.4%), the sleeve gastrectomy group (n=9,612, 15.6%) had similar all-cause mortality during the entire study period (HR=0.98, 95% CI 0.81-1.20), but decreased all-cause mortality in more recent years (HR=0.72, 95% CI 0.54-0.97, from 2014 onwards). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than gastric bypass (HR=1.54, 95% CI 1.06-2.24). 

Conclusions: The overall survival following sleeve gastrectomy seems to compare well with gastric bypass, and may even be better during recent years. A tailored surgical approach in relation to patients’ diabetes status may optimize survival in patients selected for bariatric surgery, i.e. sleeve gastrectomy for non-diabetic patients and gastric bypass for patients with diabetes. 


The study was funded by the Swedish Research Council (2019-00209) and The Swedish Society of Medicine. The funding organizations had no role in the design of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.