Meta-analysisindependent cross-checkabstract checked I-BAR-135 standard review
Meta-analysis: survival after sleeve vs bypass
Comparative survival of sleeve gastrectomy versus Roux-en-Y gastric bypass in adults with obesity: a systematic review and meta-analysis.
Overview
Sakurai et al.. Surg Obes Relat Dis 2025 · PMID 39732586 · DOI 10.1016/j.soard.2024.11.016
Sleeve was associated with about 15% lower death risk than bypass over about 3 years, but needed more revision operations.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Mortality SG vs RYGB
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
333,713
- What was actually found?
SG HR 0.85
- How large was the observed effect?
HR 0.85
- What do the results mean in everyday life?
Sleeve is not riskier for survival than bypass
- What are the study's limitations?
Observational, short
- What does it say about Elawady's specific claim?
Limits bypass-preferred claim
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Long-term difference
Scientific in-depth review
1. Full reference
- Authors
- Sakurai et al.
- Journal
- Surg Obes Relat Dis
- Year
- 2025
- Identifier
- PMID 39732586 DOI 10.1016/j.soard.2024.11.016
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement (PubMed record): Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article.
2. Research question
Does all-cause mortality differ between sleeve gastrectomy and RYGB?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis (RCTs and adjusted observational studies)
- Population
Adults with morbid obesity undergoing SG or RYGB
- Country
Multinational
- Period
Search to 30 June 2023
- Sample size
22 studies (10 RCTs, 12 observational); mortality: 3 RCTs + 7 observational, 333,713 patients
- Inclusion and exclusion criteria
Comparative SG vs RYGB studies; adjusted estimates only from observational studies
4. Methods and endpoints
- Exposure / intervention
SG
- Comparator
RYGB
- Endpoints
All-cause mortality; revision, reoperation, reintervention, hospitalisation, endoscopy
- Statistical methods
Pooled HR; meta-regression
5. Actual results
- Results
SG vs RYGB all-cause mortality HR 0.85 (0.79-0.92); reoperation HR 0.69; reintervention 0.74; hospitalisation 0.86; endoscopy 0.55; revision HR 2.18 (1.52-3.14). Weighted median follow-up 34.4 months.
- Absolute risks
not reported in abstract
- Authors' conclusion
SG was associated with lower all-cause mortality than RYGB; a large long-term RCT is needed.
6. Strengths
- Adjusted estimates only
- Large sample
7. Weaknesses
- Dominated by observational data
- Short median follow-up
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Abstract only; comment published.
9. Assessment of the statistical interpretation
HR CI narrow; observational dominance.
10. Relevance to the specific claim
Contradicts the idea that sleeve is especially deadly and that bypass is safer overall; sleeve had more revisions.
11. Independent contrary findings
Short follow-up.
12. Transferability to Germany and Europe
International.
13. Overall methodological judgement
Moderate evidence that sleeve is not more lethal than bypass in the medium term.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | unknown |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Long-term RCT.