Long-Term Outcomes to Inform Choices in Metabolic Surgery

Very quietly this week, JAMA Surgery published new data on long-term outcomes that will inform choices in metabolic surgery for years to come. We’re talking about the study of 10-year outcomes from the SM-BOSS RCT of gastric sleeve versus bypass.

It tells us that the easy choice in the short term (a gastric sleeve) might not be the best choice in the long term.

Informing Choices

This is important because it gives real, reliable data to inform the choice between these two procedures. Sometimes the choice is easy. From a medical perspective, one or the other procedure might be obviously better because of the patient’s clinical status. But for many patients, either procedure can be a reasonable choice and choosing can be hard. A sleeve is the easy choice. It seems safer in the short term and gives pretty good short-term results. In fact, the 5-year outcomes from this same RCT seemed to show that these two operations were not terribly different.

But especially for younger patients, the long term really matters and informing that long-term view is where 10-year SM-BOSS analysis really shines. It tells us four things about long-term outcomes:

1. Bypass produces a bigger reduction in weight.
2. Sleeve more often requires revision (e.g. to a bypass).
3. Gastric reflux is more common after a sleeve.
4. Complications rates and quality of life are otherwise similar.

Stopping to Think About the Long Term

Senior author Ralph Peterli describes the importance of informed decision making for “a patient who just wants to have a sleeve because he is convinced. He has a friend or a relative who has excellent results with a sleeve.” Peterli sees pros and cons to such feelings:

“If you use this ‘placebo effect’ in that patient, then it will help. But he must know he has a 34% chance of conversion (to a bypass) 10 to 14 years after surgery.”

Obesity is a chronic disease. So especially if someone has made the decision that they need metabolic surgery, the long-term outcomes are an important consideration. This new study offers insights to help people stop and think about what will be best for themselves over time.

Click here to read the study. Listen to an interview with the authors here:

Ciurana, the Path; painting by Joan Miro / WikiArt

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February 21, 2025