BEST Trial Summary: Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass

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The BEST Trial: Pioneering Insights into Bariatric Surgery Outcomes

The groundbreaking ‘BEST Trial’ (Bariatric Surgery Comparative Trial) has offered a fresh perspective on the effectiveness and safety of two prominent bariatric procedures: Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB). This registry-based, multicenter randomized clinical trial was conducted with meticulous attention to detail and patient selection to ensure the reliability and validity of its outcomes.

Objective of the BEST Trial

The central aim of the BEST Trial was to compare perioperative outcomes between Laparoscopic Sleeve Gastrectomy (SG) and Laparoscopic Roux-en-Y Gastric Bypass (RYGB), providing invaluable insights for patients and medical professionals alike. The trial included adults aged 18 years or older, with a Body Mass Index (BMI) of 35-50 kg/m2, who were accepted for bariatric surgery at participating clinics.

Methodology and Patient Demographics

A total of 1,735 patients were meticulously selected, adhering to stringent inclusion and exclusion criteria. Individuals with ongoing substance use disorder, uncontrolled psychiatric diseases, IBD, GERD, or a hiatal hernia larger than 4 cm, or those who had previously undergone bariatric or other major upper GI tract surgery, were excluded from the trial.

Detailed Comparison and Trial Outcomes

The trial featured 878 patients who underwent Laparoscopic SG and 857 who received Laparoscopic RYGB. The primary outcomes focused on the incidence of any adverse event and the incidence of a serious adverse event, with the SG group showing a 4.6% and 1.7% incidence rate, respectively, versus a 6.3% and 2.7% incidence rate in the RYGB group.

Furthermore, secondary outcomes were considered, including the 30-day readmission rate and the mean operating time. SG patients had a 3.1% readmission rate and a mean operating time of 47 minutes, in comparison to the RYGB group’s 4.0% and 68 minutes, respectively.

Conclusions from the BEST Trial

The BEST Trial concluded that among adult patients in Sweden and Norway with a BMI of 35 to 50 who underwent SG and RYGB, perioperative morbidity was low and not significantly different between the groups. It suggested that the perioperative risk should be of limited focus in the choice between SG or RYGB.

Implications for Bariatric Surgery

The insights provided by the BEST Trial are invaluable in guiding medical professionals and patients when choosing the appropriate bariatric surgery technique. The trial’s thorough approach and significant findings help shape a safer and more effective landscape for weight-loss surgeries.

In a domain where every patient’s health and well-being are paramount, the BEST Trial stands out as a benchmark for comparative clinical research. The data it provides serves as a foundation for making informed decisions in bariatric surgery, reinforcing the fact that patient safety and positive outcomes are the cornerstones of successful surgical interventions.


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