Conrad Moher, MD, Daniel Skubleny, MD, Jerry T Dang, MD, Daniel W Birch, MD, FRCSC, Shahzeer Karmali, MD, FRCSC. University of Alberta
Introduction: The aim of this study is to determine whether MGB may be a reasonable alternative to RYGB by comparing post-operative complication rates. Mini-gastric bypass (MGB) is continuing to gain evidence as a viable bariatric procedure. Compared to the two-anastomosis laparoscopic Roux-en-Y gastric bypass (RYGB), the MGB is performed with a single gastrojejunal anastomosis and is arguably a simpler and faster procedure in experienced hands. Significant criticism surrounds the MGB, including complications related to bile-acid reflux and the potential risk of future gastro-esophageal cancer.
Systematic reviews from Europe and Asia have established MGB as a safe and effective procedure. North American comparisons of MGB and RYGB are currently limited. This is the first study using the MBSAQIP database to compare MGB and RYGB.
Methods and Procedures: This is a retrospective study using the MBSAQIP database. Univariate and multivariable analyses on multiple outcome measures for all primary MGB and RYGB procedures was performed. Revisional procedures were excluded. Data analyzed included demographic information, operative time, perioperative outcomes, and complication rates. Measured 30-day outcomes included: death, venous thromboembolism (VTE), bleed, leak, re-operation, re-admission, length of stay, and re-intervention.
Results: From 2015-2016, a total of 112 MGB and 78,883 RYGB were performed. There was no difference in patient demographics except: mean body mass index (BMI) (MGB=44.0, RYGB=46.3; p=0.059), dialysis dependence (MGB=0.9%, RYGB=0.2%; p=0.064), history of DVT (MGB=4.5%, RYGB=1.9%; p=0.040), and therapeutic anticoagulant use (MGB=8.9%, RYGB=2.6%; p=0.000). Mean operative time was longer for MGB (MGB=135.6 minutes, RYGB=119.6 minutes; p=0.002). 30-day complication rates showed no significant difference in mortality, leak, bleed, re-operation and re-intervention. Significant differences were found in rates of VTE (MGB= 1.8%, RYGB= 0.4%, p=0.025), readmission (MGB=9.8%, RYGB= 6.1%; p=0.099), length of stay lasting greater than 7 days (MGB=3.6%, RYGB=1.0%; p=0.007), and acute renal failure (MGB=0.9%, RYGB=0.1%; p=0.026).
Conclusions: Our analysis of the MBSAQIP database found that MGB had longer operative times and increased complications in several categories. Significant discrepancy in data volume between MGB and RYGB within the MBSAQIP database limits the ability to establish robust conclusions. Surgical volume and differences in geographical procedural preferences likely contributes to the increased complications found for MGB. The need for additional MGB data within the MBSAQIP database must be balanced with the notion that surgeons should continue to perform procedures in which they maintain large volumes in order to mitigate procedural complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95751
Program Number: P173
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster