Laparoscopic Roux-en-Y gastric bypass patients have an increased lifetime risk of re-operations when compared to laparoscopic sleeve gastrectomy patients.

Yulia Zak, MD, Emil Petrusa, PhD, Denise W Gee, MD. Massachusetts General Hospital

OBJECTIVES: Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) both result in significant weight loss and reduction of comorbidities in the morbidly obese population. Although long-term data has been published on the complications after RYGB, sleeve gastrectomy is a relatively new procedure without a well-established long-term procedure-related morbidity profile. Our aim was to compare the 5-year data on re-operations occurring after and related to RYGB versus SG at a large academic bariatric center.

METHODS: Retrospective review of all the bariatric procedures at the Massachusetts General Hospital between 2009 and 2014.

RESULTS: A total of 934 laparoscopic RYGB and 553 SG were performed. There were no significant differences in the gender, age, or BMI of the patients at the time of their index operations (p > 0.05 for all). A higher percentage of RYGB patients required cholecystectomy as compared to SG patients (5% vs. 2%, X2 = 8.63, p < 0.01). There was also a significant difference in the proportion of patients requiring re-operations for other reasons following RYGB as compared to SG (6.9% vs. 0.9%, X2 = 27.8, p < .01). 32.8% of these bypass patients underwent more than one re-operation. This confers a relative risk of 11.5 (95% CI 4.69-28.5) onto the patients undergoing RYGB as compared to those undergoing SG.

Most of the reoperations after SG were performed within 2 days of the index procedure for hemorrhage. The distribution of re-operations in the bypass population was bimodal. 9.3% of secondary operations occured at a mean of 1 month after the RYGB for functional obstruction, with 80% of these cases related to a technical error. The rest of re-operations occurred in a delayed fashion, with abdominal pain/nausea/emesis without a clearly identifiable intra-abdominal source (22.2%), adhesive bowel obstruction (17.6%), and internal hernia (15.7%) being the most common causes. These occurred at a mean 20, 22, and 21 months, respectively. Non-healing ulcers and intussusception were responsible for a very small percentage of re-operations (3.7% and 2.8%). However, they were associated with the highest weight loss at the time of those procedures (mean change in BMI 20.8 and 19.6 kg/m2, respectively).

CONCLUSIONS: SG is associated with a relatively low rate of re-operations, while patients after RYGB are at a significant lifetime risk for multiple operative procedures. Although the current data shows that RYGB may lead to slightly better weight loss and reduction of diabetes mellitus, this may be outweighed by the long-term morbidity of potential repeat operations. The relative risk of re-operations after RYGB must be considered when making the initial choice of a specific bariatric procedure.

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