A Comparison of Short-Term Morbidity in Laparoscopic Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass

Pei-Wen Lim MD, Jonathan E Miller, Richard Perugini MD, John J Kelly MD, Donald Czerniach MD, Philip Cohen MD. UMass Memorial Medical Center

Background Laparoscopic sleeve gastrectomy (LSG) has rapidly gained popularity and is presently the most commonly performed bariatric procedure in the United States. One explanation for this shift is the view of LSG as a generally safer alternative to Roux-en-Y Gastric Bypass (RYGB) with regards to short-term complications (hemorrhage, staple line leak) and long-term complications (anastomotic ulcer, intestinal obstruction, micronutrient deficiency). We sought to conduct a systematic review comparing our initial series of LSG to a concurrent series of RYGB to evaluate short-term morbidity between these two procedures.

Methods A registry was conducted of patients (n = 345) who underwent LSG at UMass Memorial Health Care between July 2010 and June 2014. Data included demographics and comorbidities, metabolic status, length of stay, operative technique, rates of complication and readmission, and excess bodyweight loss at postoperative follow-up. Rates of complication and readmission for our concurrent RYGB series (n = 1210) were extracted from the MBSAQIP 30-day occurrence rate report. Univariate analysis was utilized to compare rate of transfusion, readmission, leak, DVT/PE, and mortality.

Results Barring rate of leak, no other statistically significant differences in rate of postoperative complication were identified between procedures. Leak occurred more frequently in our LSG series (1.2% vs. 0.1%, p = 0.01). Rate of transfusion (2.9% in LSG and 2.1% in RYGB, p = 0.41), rate of readmission (5.8% in LSG and 6.7% in RYGB, p = 0.62), rate of DVT/PE (0.9% in LSG and 0.3% in RYGB, p = 0.19), and mortality (0.3% in LSG and 0% in RYGB, p = 0.22) did not vary significantly between LSG and RYGB.

Conclusion The hypothesis that LSG has a lower rate of short-term complications than RYGB is not supported by our inception series. The higher rate of leak associated with LSG, a significant complication of this procedure, highlights the importance of investigating strategies that may diminish this risk in the future.