Comparison of Surgical Outcomes Between Laparoscopic Sleeve Gastrectomy (LSG) Versus Laparoscopic Sleeve Gastrectomy With Proximal Jejunal Bypass (LSG With PJB) in Patients With Severe Obesity (BMI ≥ 50 kg/m2).

BACKGROUND: The optimal bariatric procedure for patients with severe obesity (BMI ≥ 50 kg/m2) remains debated. This study compares standard laparoscopic sleeve gastrectomy (LSG) with an emerging metabolic intervention, LSG with proximal jejunal bypass (LSG + PJB). METHODS: A retroprospective study (January 2022-December 2024) included 48 patients with severe obesity, divided into LSG (n = 25) and LSG + PJB (n = 23) groups. Outcomes evaluated included percent excess weight loss (%EWL), percent total weight loss (%TWL), HbA1C, complete diabetes mellitus (DM) remission, operative time, length of stay (LOS), and complications. The study protocol was approved by the Institutional Review Board of Rajavithi Hospital (Approval No. 68184). RESULTS: At 12 months, both groups achieved significant weight reduction. LSG + PJB showed higher mean %EWL (52.05% vs. 42.27%) and %TWL (28.74% vs. 24.71%) than LSG, though statistically insignificant. However, LSG + PJB demonstrated significantly superior metabolic outcomes, including a higher complete DM remission rate (100% vs. 66.7%, p = 0.047) and greater reductions in HbA1C (p = 0.001), fasting blood sugar (p = 0.005), and C-peptide (p = 0.026). While operative time was longer for LSG + PJB (183.3 vs. 113 min), LOS and major complications were comparable. Notably, the LSG group experienced higher rates of constipation (16%, p = 0.045) and GERD (12%, p = 0.086). CONCLUSION: Both procedures effectively achieve weight loss in patients with severe obesity. Nevertheless, LSG + PJB yields significantly superior glycemic control and DM remission with a comparable safety profile, making it a highly effective surgical alternative, particularly for patients with comorbid Type 2 diabetes.