GASTRIC BYPASS, SLEEVE GASTRECTOMY, AND HYBRID TECHNIQUES IN BARIATRIC SURGERY: LONG-TERM COMPARATIVE EVIDENCE ON EFFICACY, SAFETY, AND METABOLIC OUTCOMES

Abstract

Bariatric and metabolic surgery is the most effective intervention for severe obesity and its comorbidities. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (LSG) are the most widely performed procedures, while hybrid techniques such as OAGB/MGB, SADI-S, and SASI have gained relevance in the last decade. This study aimed to compare long-term clinical outcomes, including weight loss, metabolic remission, reflux, surgical revisions, and nutritional complications. A systematic review of studies published between 2015 and 2025 was conducted in PubMed, Embase, Cochrane, LILACS, and BVS, including randomized controlled trials and cohorts with a minimum of five years’ follow-up. Twenty-seven studies were included (n=15,238). RYGB showed superior performance in reflux control and more consistent metabolic outcomes, whereas LSG, despite its wide adoption, was consistently associated with higher rates of new GERD and surgical revisions. Hybrid techniques achieved greater weight loss and diabetes remission but carried a higher risk of nutritional complications. SASI showed promising mid-term results, though still limited. In conclusion, no single procedure fully balances efficacy and safety, and surgical choice should be individualized based on clinical profile and regional context.