Comparison of Surgical Outcomes Between Laparoscopic Sleeve Gastrectomy (LSG) Versus Laparoscopic Sleeve Gastrectomy With Proximal Jejunal Bypass (LSG With PJB) in Patients With Severe Obesity (BMI ≥ 50 kg/m2).

Background

The optimal bariatric procedure for patients with severe obesity (BMI ≥ 50 kg/m2) remains debated. This study compares standard laparoscopic sleeve gastrectomy (LSG) with an emerging metabolic intervention, LSG with proximal jejunal bypass (LSG + PJB).

Methods

A retroprospective study (January 2022-December 2024) included 48 patients with severe obesity, divided into LSG (n = 25) and LSG + PJB (n = 23) groups. Outcomes evaluated included percent excess weight loss (%EWL), percent total weight loss (%TWL), HbA1C, complete diabetes mellitus (DM) remission, operative time, length of stay (LOS), and complications. The study protocol was approved by the Institutional Review Board of Rajavithi Hospital (Approval No. 68184).

Results

At 12 months, both groups achieved significant weight reduction. LSG + PJB showed higher mean %EWL (52.05% vs. 42.27%) and %TWL (28.74% vs. 24.71%) than LSG, though statistically insignificant. However, LSG + PJB demonstrated significantly superior metabolic outcomes, including a higher complete DM remission rate (100% vs. 66.7%, p = 0.047) and greater reductions in HbA1C (p = 0.001), fasting blood sugar (p = 0.005), and C-peptide (p = 0.026). While operative time was longer for LSG + PJB (183.3 vs. 113 min), LOS and major complications were comparable. Notably, the LSG group experienced higher rates of constipation (16%, p = 0.045) and GERD (12%, p = 0.086).

Conclusion

Both procedures effectively achieve weight loss in patients with severe obesity. Nevertheless, LSG + PJB yields significantly superior glycemic control and DM remission with a comparable safety profile, making it a highly effective surgical alternative, particularly for patients with comorbid Type 2 diabetes.