Gastric bypass surgery linked to lower heart attack risk than gastric sleeve
Patients may face a significantly lower risk of major heart issues if treated with gastric bypass surgery than gastric sleeve surgery, according to new findings published in JAMA Surgery.[1]
“New obesity management medications, such as glucagon-like peptide-1 receptor agonists, have demonstrated promising results for weight reduction. However, sustainable long-term weight loss, especially after cessation of the drugs, has yet to be confirmed,” wrote first author Simone Wildisen, MMed, a researcher with Medical University Clinic in Aarau, Switzerland, and colleagues. “Additionally, challenges persist with medication adherence and availability. Until further research provides more definitive long-term outcomes, metabolic bariatric surgery (MBS) remains the most effective and sustainable treatment for severe obesity.”
Wildisen et al. explored long-term data from more than 39,000 adult patients to compare the two most popular MBS options, gastric bypass surgery and sleeve gastrectomy, which is also commonly known as gastric sleeve surgery. While 77.5% of patients underwent gastric bypass, the other 22.5% underwent sleeve gastrectomy.
Over a median follow-up period of more than five years, the study’s primary endpoint—a composite of myocardial infarction (MI), ischemic stroke, heart failure and all-cause mortality—occurred in 1.9% of gastric bypass patients and 3% of sleeve gastrectomy patients. This difference was primarily driven by the reduced MI risk for gastric bypass patients. All other event rates were comparable between the two treatment types.
Gastric bypass was also associated with reduced risks of conversion surgery—defined as any operation that modified the index MBS—and peptic ulcer disease.
On the other hand, reoperation for revision of the initial surgery was significantly more likely after gastric bypass than after sleeve gastrectomy—the authors noted that this is due to the “complex nature” of gastric bypass operations.
In-hospital mortality and in-hospital complications were similar for the two treatment options, the authors added. However, after using inverse probability of treatment weighting, gastric bypass was linked to an increased risk of in-hospital complications.
“Sleeve gastrectomy has gained popularity due to its perceived safety and shorter operating times, surpassing gastric bypass in recent years,” the authors wrote. “However, recent reviews indicate a decline in sleeve gastrectomy usage since 2018, reflecting concerns over long-term outcomes like recurrent weight gain and new-onset gastroesophageal reflux disease, leading to more frequent surgical conversions. Our findings support this trend, showing a higher risk for conversion surgery after sleeve gastrectomy.”
They concluded their analysis by highlighting the benefits seen in patients undergoing treatment with gastric bypass surgery.
“While both procedures are effective for weight loss and improving cardiovascular outcomes, gastric bypass may be associated with greater cardiovascular benefits,” the group wrote. “However, this must be balanced against its higher risk of postoperative complications and the need for surgical revisions, emphasizing the importance of individualized patient selection and shared decision-making in clinical practice.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.