Six-month weight loss and comorbidity remission after sleeve gastrectomy, Roux-en-Y gastric bypass, BPD-DS, and SADI-S: propensity score analysis using the 2023 MBSAQIP database

Why clinicians should know about it

• Picked for Bariatric and Metabolic Surgery (paper of the day, 11 September 2026): Propensity-matched comparison of weight loss and comorbidity remission

Abstract

BACKGROUND: Bariatric surgery remains the most effective treatment for obesity, yet nationwide bariatric-specific data evaluating early weight loss and comorbidity remission across contemporary procedures are limited. We aimed to compare 6-month outcomes after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). METHODS: We analyzed adults aged 18-65 years who underwent primary laparoscopic or robotic SG, RYGB, BPD-DS, or SADI-S in the 2023 MBSAQIP database with available long-term follow-up PUF data. Six pairwise 1:1 propensity score-matched analyses were performed using 47 preoperative, intraoperative, and postoperative variables. Outcomes included 6-month weight loss and remission of diabetes, hypertension, hyperlipidemia, sleep apnea, and gastroesophageal reflux disease (GERD). RESULTS: A total of 116,195 patients were included: 80,614 SG, 33,148 RYGB, 1518 BPD-DS, and 915 SADI-S. Compared with SG, RYGB showed higher remission of diabetes (64.1% vs. 58.1%), hypertension (41.9% vs. 35.8%), hyperlipidemia (43.0% vs. 37.1%), and GERD (55.6% vs. 44.9%), as well as greater %EWL (50.13% vs. 43.63%) (all p < 0.05). Among all procedures, BPD-DS achieved the greatest weight-loss outcomes, with higher %EWL than SG (52.37% vs. 37.73%), RYGB (52.35% vs. 45.92%), and SADI-S (51.07% vs. 45.02%) (all p < 0.05). BPD-DS also showed greater metabolic benefits, including higher diabetes remission than SG (73.3% vs. 59.9%), RYGB (73.1% vs. 65.6%), and SADI-S (77.4% vs. 66.1%), as well as higher hypertension remission than SG (46.0% vs. 31.6%) and RYGB (46.2% vs. 37.6%) (all p < 0.05). Finally, SADI-S showed a similar weight-loss profile to RYGB, with no significant difference in %EWL (44.99% vs. 44.73%, p = 0.126), and comparable remission rates for most evaluated comorbidities. CONCLUSION: In our national propensity-matched analysis, all evaluated bariatric procedures were associated with significant improvements in weight loss and comorbidity remission. However, RYGB demonstrated higher remission rates than SG, whereas BPD-DS achieved the most favorable 6-month weight-loss and cardiometabolic outcomes among all procedures.

Abstract as published, via PubMed.