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Long-term Survival After Sleeve Gastrectomy Versus Gastric Bypass in a Binational Cohort Study

Research output: Contribution to journalArticlepeer-review

Dag Holmberg, Giola Santoni, Joonas H. Kauppila, Sheraz R. Markar, Jesper Lagergren

Original languageEnglish
Pages (from-to)1981-1986
Number of pages6
JournalDiabetes Care
Issue number9
Accepted/In press20 May 2022
Published1 Sep 2022

Bibliographical note

Funding Information: Funding. The study was funded by Vetenskaps-rådet (The Swedish Research Council) (2019-00209) and Svenska L€akares€allskapet (Swedish Society of Medicine). Publisher Copyright: © 2022, American Diabetes Association Inc.. All rights reserved.

King's Authors


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 of primary laparoscopic sleeve gastrectomy compared with gastric bypass for obesity in Sweden and Finland between 1 January 2007 and 31 December 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs 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 with 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 onward). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than after 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 patients without diabetes and gastric bypass for patients with diabetes).

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