Comparable lipid profile improvements after sleeve gastrectomy and Roux-en-Y gastric bypass: findings from a single center retrospective cohort

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BACKGROUND: Metabolic and bariatric surgery (MBS) is the most effective intervention for severe obesity and its metabolic complications, including dyslipidemia. Although several surgical techniques are available, evidence regarding their differential effects on lipid profiles remains inconsistent. OBJECTIVE: To compare the effects of sleeve gastrectomy (SG), primary Roux-en-Y gastric bypass (RYGB), and revisional RYGB (R-RYGB) on postoperative lipid profiles during the first year after surgery. METHODS: This retrospective cohort study included 200 patients with severe obesity who underwent SG (n = 120), RYGB (n = 38), or R-RYGB (n = 42) between 2019 and 2023. Demographic characteristics, BMI, and lipid parameters [total cholesterol (TC), triglycerides (TG), LDL-C, and high-density lipoprotein cholesterol] were assessed at baseline, 6 months, and 12 months. Between-group comparisons were performed using the Kruskal–Wallis test, and within-group changes were analyzed using mixed-effects and Δ-change models. RESULTS: All three surgical groups achieved significant reductions in BMI, TC, TG, and LDL-C, along with increases in HDL-C at 6 and 12 months (all p < 0.001 within groups). Between-group analyses revealed no statistically significant differences in lipid improvements, although patients who underwent SG showed numerically greater HDL elevation and TG reduction. Δ-change analysis confirmed that lipid improvements were comparable across the SG, RYGB, and R-RYGB groups, whereas BMI reduction at 12 months was slightly greater in the SG group (p = 0.010). CONCLUSIONS: SG, RYGB, and R-RYGB each produced substantial and clinically relevant improvements in dyslipidemia during the first postoperative year, with no evidence of superiority among the techniques. For people with obesity and dyslipidemia, the decisive factor is the performance of metabolic and bariatric surgery rather than the choice of procedure. All approaches confer meaningful reductions in atherogenic lipids and improvements in cardioprotective parameters, thereby contributing to long-term cardiovascular risk reduction.

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