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The 10-year SLEEVEPASS randomized clinical trial provides unusually long follow-up comparing laparoscopic sleeve gastrectomy with Roux-en-Y gastric bypass in patients with obesity. Both procedures produced durable weight loss and meaningful improvement in obesity-related comorbidities, but the long-term profiles were not identical. Gastric bypass generally offered greater weight reduction and better reflux outcomes, while sleeve gastrectomy remained an effective operation with its own technical advantages. The study is particularly important for preoperative counseling because many differences between bariatric procedures emerge over years rather than during the initial postoperative period. Long-term reflux, weight trajectory, metabolic disease and the possibility of revisional surgery should therefore be discussed before selecting an operation. For bariatric teams, the trial also illustrates why outcome assessment should extend beyond percentage weight loss: the best procedure is the one that offers an acceptable balance of efficacy, adverse effects, technical considerations and patient preferences. Ten-year randomized evidence strengthens shared decision-making between surgeon and patient.
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The 10-year SLEEVEPASS randomized clinical trial provides unusually long follow-up comparing laparoscopic sleeve gastrectomy with Roux-en-Y gastric bypass in patients with obesity. Both procedures produced durable weight loss and meaningful improvement in obesity-related comorbidities, but the long-term profiles were not identical. Gastric bypass generally offered greater weight reduction and better reflux outcomes, while sleeve gastrectomy remained an effective operation with its own technical advantages. The study is particularly important for preoperative counseling because many differences between bariatric procedures emerge over years rather than during the initial postoperative period. Long-term reflux, weight trajectory, metabolic disease and the possibility of revisional surgery should therefore be discussed before selecting an operation. For bariatric teams, the trial also illustrates why outcome assessment should extend beyond percentage weight loss: the best procedure is the one that offers an acceptable balance of efficacy, adverse effects, technical considerations and patient preferences. Ten-year randomized evidence strengthens shared decision-making between surgeon and patient.
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