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Seven years after surgery, laparoscopic Roux-en-Y gastric bypass yielded better weight loss than sleeve gastrectomy, according to new data from the randomized .

People with morbid obesity assigned to gastric bypass lost on average 55% (95% CI 52%-59%) of baseline body weight versus 47% for sleeve gastrectomy patients (95% CI 43%-50%) at 7-year follow-up, Paulina Salminen, MD, PhD, of Turku University Hospital in Finland, and colleagues wrote in .

This difference of nearly nine percentage points meant the two surgery types didn't meet prespecified criteria for equivalence, Turku and colleagues indicated.

The multicenter, multi-surgeon trial included 240 patients randomized 1:1 to these procedures in Finland. Participants' mean baseline BMI was 45.9.

At year seven, both groups had similar rates of complications: 24.0% for sleeve gastrectomy patients and 28.6% with gastric bypass (P=0.42). As for major late-stage complications occurring 5 to 7 years post-operative, gastroesophageal reflux was the only one affecting sleeve gastrectomy patients, while hernias and resections were the only events among gastric bypass patients.

Neither type of surgery outperformed the other for disease-specific quality of life. Overall scores on a standard scale -- the Moorehead-Ardelt Quality of Life questionnaire of the Bariatric Analysis and Reporting Outcome System -- averaged 0.50 and 0.49, for sleeve gastrectomy and gastric bypass, respectively (P=0.63). This measure inquires into self-esteem and daily activities such as social life, work, and sexual activity.

Disease-specific quality of life did improve with both procedures from baseline through seven years. And not surprisingly, greater weight loss was tied to better disease-specific quality of life score (r=0.26, P<0.001).

Sleeve gastrectomy and gastric bypass patients saw similar median scores for general health-related quality of life at year seven (0.88 and 0.87, respectively, P=0.37), without changing markedly from baseline in either group. This outcome was measured with a 15-dimensional questionnaire, touching on factors such as breathing, mental function, speech/communication, vision, mobility, usual activities, vitality, hearing, eating, elimination, sleeping, distress, discomfort and symptoms, sexual activity, and depression.

Salminen's group suggested that the higher incidence of GERD and Barrett's esophagus after sleeve gastrectomy may play into how patients rate their long-term quality of life. They also called for these complications to be followed in future randomized trials, and said their own study will examine them at 10-year follow-up, "allowing comparison with preoperative esophageal status."

In an , Amir Ghaferi, MD, MS, of the University of Michigan in Ann Arbor, and colleagues noted the puzzle of disease-specific quality of life improving without a corresponding increase in health-related quality of life. One possible explanation, they said, is that "variation in expected [versus] actual weight loss after surgery could influence how satisfied patients were with their surgical outcome and also how they scored their health-related [quality of life]."

Although the commentators praised the authors for using validated quality of life measures, they highlighted that a major limitation to these findings is a lack of more detailed data on mental health-related outcomes, specifically looking at depression, anxiety, and bipolar disease.

"As such, clinicians should be prepared to not only discuss the short- and long-term risks and benefits of each procedure, but also recognize that patients may have different goals and expectations from themselves and each other," Ghaferi's group wrote. "To that end, this study adds much needed data to the conversation about the effect of bariatric surgery on QoL measures, which may represent the most important outcome for some patients."

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