Comparative Efficacy of Mini Gastric Bypass and Sleeve Gastrectomy in Improving Metabolic Parameters and Promoting Weight Loss in Patients with Morbid Obesity: A Cohort Study

Makhsosi, Behnamreza ---; Yarizadeh, Reza ---; Azadmehr, Arash ---

doi:10.22034/ijs.2026.2092146.1017

Comparative Efficacy of Mini Gastric Bypass and Sleeve Gastrectomy in Improving Metabolic Parameters and Promoting Weight Loss in Patients with Morbid Obesity: A Cohort Study

Document Type : Original Article

Authors

Behnamreza --- Makhsosi ¹

Reza --- Yarizadeh ²

Arash --- Azadmehr ²

¹ Department of General Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

² Department of General Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

10.22034/ijs.2026.2092146.1017

Abstract

Background and Objective: Morbid obesity is associated with a wide spectrum of metabolic complications, and bariatric surgery represents the most effective intervention for achieving sustainable weight loss and alleviating these comorbidities. This study aimed to compare the efficacy of two surgical procedures, mini gastric bypass (MGB) and sleeve gastrectomy (SG), on anthropometric measurements, metabolic profiles, and clinical outcomes in patients with morbid obesity.
Methods: This prospective longitudinal cohort study included 160 patients with morbid obesity (n=80 per group) who underwent either SG or MGB in 2024 at medical centers affiliated with Kermanshah University of Medical Sciences. Body weight was assessed at baseline and at 1, 3, and 9 months postoperatively. Laboratory parameters-including fasting blood glucose, triglycerides, total cholesterol, HDL, and LDL-along with systolic blood pressure (SBP), hepatic steatosis grade, and musculoskeletal pain were evaluated at baseline and at month 9. Statistical analyses were conducted using repeated measures analysis of variance (RM-ANOVA), Bonferroni post-hoc tests, independent t-tests, and Chi-square tests in SPSS version 26, with significance set at P<0.05.
Results: The mean age of the MGB group was significantly higher than that of the SG group
(P=0.001). Both procedures led to a significant reduction in weight over time (P<0.001), with a significant interaction effect between time and surgical approach (P=0.004). Although the absolute weight loss at the end of the month 9 did not differ significantly between the two groups (P=0.068),
total weight loss percentage (%TWL) was significantly greater in the SG group than in the MGB group (P=0.002). In metabolic evaluations, MGB demonstrated significant superiority in reducing triglycerides (P=0.006) and total cholesterol (P=0.002), as well as in increasing HDL levels (P=0.001). However, no significant differences were observed between the two methods regarding LDL reduction (P=0.282), percentage reduction in fasting blood glucose (P=0.205), or systolic blood pressure control (P =0.217). Furthermore, in both groups, grade 3 hepatic steatosis was completely eradicated, and complete resolution (100%) of musculoskeletal pain was achieved by month 9 (P<0.001).
Conclusion: Both SG and MGB are effective surgical approaches for weight control and the management of clinical comorbidities in morbid obesity. However, SG showed superiority in percentage of TWL, whereas MGB was more effective in correcting dyslipidemia. Therefore, the choice of surgical technique should be tailored to the individual patient’s metabolic phenotype.

Keywords

Gastric Bypass

Obesity, Morbid

Weight Loss

1. WHO L. World Health Organization. Obesity and Overweight. WHO Geneva, Switzerland; 2017.

2. Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015; 33(7): 673-89.

3. Shah S, Abbas G, Aslam A, Randhawa FA, Khan FU, Khurram H, et al. Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity. PLoS One. 2023; 18(8): e0289502.

4. Xu Y, Jia W, Niu X, Wen J, Ji D, Li X, et al. Prevalence and Comorbidity Network Analysis of Obesity and Related Complications: A Real-World Study Based on 233,004 Individuals. Diabetes, Metabolic Syndrome and Obesity. 2025: 3297-314.

5. Abdullah A, Peeters A, de Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes research and clinical practice. 2010; 89(3): 309-19.

6. Kim JC, Kim M-G, Park JK, Lee S, Kim J, Cho Y-S, et al. Outcomes and adverse events after bariatric surgery: an updated systematic review and
meta-analysis, 2013–2023. Journal of Metabolic and Bariatric Surgery. 2023; 12(2):76.

7. Courcoulas AP, Patti ME, Hu B, Arterburn DE, Simonson DC, Gourash WF, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes. Jama. 2024; 331(8): 654-64.

8. Angrisani L, Santonicola A, Iovino P, Palma R, Kow L, Prager G, et al. IFSO worldwide survey
2020–2021: current trends for bariatric and metabolic procedures. Obesity Surgery. 2024; 34(4): 1075-85.

9. Ataya K, Patel N, Aljaafreh A, Melebari SS, Yang W, Guillen C, et al. Outcomes of single anastomosis sleeve ileal (SASI) bypass as an alternative procedure in treating obesity: an updated systematic review and meta-analysis. Obesity Surgery. 2024; 34(9):3285-97.

10. Ruiz-Tovar J, Carbajo MA, Jimenez JM, Castro MJ, Gonzalez G, Ortiz-de-Solorzano J, et al. RETRACTED ARTICLE: Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities. Surgical endoscopy. 2019; 33(2): 401-10.

11. Mahdy T, Emile SH, Madyan A, Schou C, Alwahidi A, Ribeiro R, et al. Evaluation of the efficacy of single anastomosis sleeve ileal (SASI) bypass for patients with morbid obesity: a multicenter study. Obesity surgery. 2020; 30(3): 837-45.

12. Buchwald H, Avidor Y, Braunwald E. Bariatric surgery. A systematic review and meta-analysis. ACC Current Journal Review. 2005; 1 (14. 13).

13. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004; 292(14): 1724-37.

14. Georgiadou D, Sergentanis TN, Nixon A, Diamantis T, Tsigris C, Psaltopoulou T. Efficacy and safety of laparoscopic mini gastric bypass. A systematic review. Surgery for obesity and related diseases. 2014; 10(5): 984-91.

15. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Annals of internal medicine. 2005; 142(7): 547-59.

16. Berthoud H-R, Morrison C. The brain, appetite, and obesity. Annu Rev Psychol. 2008; 59(1): 55-92.

17. Ammar W, Basset HA, Al Faramawy A, Hegazy T, Sharaf Y. Bariatric surgery and cardiovascular outcome. The Egyptian Heart Journal. 2020;72:1-10.

18. Persson CE, Björck L, Lagergren J, Lappas G, Giang KW, Rosengren A. Risk of heart failure in obese patients with and without bariatric surgery in Sweden-a registry-based study. Journal of Cardiac Failure. 2017; 23(7): 530-7.

19. Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of obesity and weight loss on cardiac performance and morphology in adults. Progress in cardiovascular diseases. 2014; 56(4): 391-400.

20. Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, et al. Laparoscopic mini-gastric bypass: short-term single-institute experience. Updates in surgery. 2011; 63: 239-42.

21. Bray GA. Medical consequences of obesity. The Journal of clinical endocrinology & metabolism. 2004; 89(6): 2583-9.

22. Must A, Spadano J, Coakley EH, Field AE,
Colditz G, Dietz WH. The disease burden associated with overweight and obesity. Jama. 1999; 282(16): 1523-9