Comparison of Early Post-operative Complications in Primary and Revisional Laparoscopic Sleeve Gastrectomy, Gastric Bypass, and Duodenal Switch MBSAQIP-reported Cases from 2015 to 2019

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2023 Jan 18

PMID 36653536

Authors

William C Bennett

Ian C Garbarine

Murphy Mostellar

Jeffrey Lipman

Manuel Sanchez-Casalongue

Timothy Farrell

Randal Zhou

Affiliations

Soon will be listed here.

Abstract

Background: Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts.

Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities.

Results: Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]).

Conclusions: Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.

Citing Articles

Long-Term Safety and Efficacy Profile of Bariatric Surgery in Patients Classified with ASA IV Status.

Jawhar N, Abi Mosleh K, Muthusamy K, Gajjar A, Betancourt R, Laplante S Obes Surg. 2025; 35(3):701-714.

PMID: 39971869 DOI: 10.1007/s11695-025-07753-4.

The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic.

Jawhar N, Sample J, Salame M, Marrero K, Tomey D, Puvvadi S J Clin Med. 2024; 13(7).

PMID: 38610643 PMC: 11012271. DOI: 10.3390/jcm13071878.

Is Routine Post-operative Biological Laboratory Assessment Necessary After Sleeve Gastrectomy?.

Triantafyllou E, Scholer V, Calabrese D, Ribeiro-Parenti L, Msika S, Rebibo L Obes Surg. 2024; 34(3):707-715.

PMID: 38273145 DOI: 10.1007/s11695-024-07065-z.

References

Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J . IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018; 28(12):3783-3794. DOI: 10.1007/s11695-018-3450-2. View

Alalwan A, Friedman J, Park H, Segal R, Brumback B, Hartzema A . US national trends in bariatric surgery: A decade of study. Surgery. 2021; 170(1):13-17. DOI: 10.1016/j.surg.2021.02.002. View

Guraya S, Strate T . Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus: A systematic review and meta-analysis. World J Gastroenterol. 2020; 26(8):865-876. PMC: 7052530. DOI: 10.3748/wjg.v26.i8.865. View

Peterli R, Wolnerhanssen B, Peters T, Vetter D, Kroll D, Borbely Y . Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA. 2018; 319(3):255-265. PMC: 5833546. DOI: 10.1001/jama.2017.20897. View

Andalib A, Alamri H, Almuhanna Y, Bouchard P, Demyttenaere S, Court O . Short-term outcomes of revisional surgery after sleeve gastrectomy: a comparative analysis of re-sleeve, Roux en-Y gastric bypass, duodenal switch (Roux en-Y and single-anastomosis). Surg Endosc. 2020; 35(8):4644-4652. DOI: 10.1007/s00464-020-07891-z. View

Colquitt J, Pickett K, Loveman E, Frampton G . Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014; (8):CD003641. PMC: 9028049. DOI: 10.1002/14651858.CD003641.pub4. View

Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer P, Brethauer S . Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013; 23(11):1766-73. DOI: 10.1007/s11695-013-1012-1. View

Clapp B, Wynn M, Martyn C, Foster C, ODell M, Tyroch A . Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis. 2018; 14(6):741-747. DOI: 10.1016/j.soard.2018.02.027. View

Andalib A, Aminian A, Khorgami Z, Navaneethan S, Schauer P, Brethauer S . Safety analysis of primary bariatric surgery in patients on chronic dialysis. Surg Endosc. 2015; 30(6):2583-91. DOI: 10.1007/s00464-015-4530-1. View

10.

Andalib A, Aminian A, Khorgami Z, Jamal M, Augustin T, Schauer P . Early Postoperative Outcomes of Primary Bariatric Surgery in Patients on Chronic Steroid or Immunosuppressive Therapy. Obes Surg. 2015; 26(7):1479-86. DOI: 10.1007/s11695-015-1923-0. View

11.

Aminian A . Bariatric procedure selection in patients with type 2 diabetes: choice between Roux-en-Y gastric bypass or sleeve gastrectomy. Surg Obes Relat Dis. 2020; 16(2):332-339. DOI: 10.1016/j.soard.2019.11.013. View

12.

Ban K, Minei J, Laronga C, Harbrecht B, Jensen E, Fry D . American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016; 224(1):59-74. DOI: 10.1016/j.jamcollsurg.2016.10.029. View

13.

Berrios-Torres S, Umscheid C, Bratzler D, Leas B, Stone E, Kelz R . Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152(8):784-791. DOI: 10.1001/jamasurg.2017.0904. View

14.

Macefield R, Reeves B, Milne T, Nicholson A, Blencowe N, Calvert M . Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion. J Infect Prev. 2017; 18(4):170-179. PMC: 5495441. DOI: 10.1177/1757177416689724. View

15.

Stone P . Changes in Medicare reimbursement for hospital-acquired conditions including infections. Am J Infect Control. 2009; 37(9):A17-8. DOI: 10.1016/j.ajic.2009.07.001. View

16.

Magill S, Edwards J, Bamberg W, Beldavs Z, Dumyati G, Kainer M . Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014; 370(13):1198-208. PMC: 4648343. DOI: 10.1056/NEJMoa1306801. View

17.

Conley M, McFarlane C, Johnson D, Kelly J, Campbell K, MacLaughlin H . Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database Syst Rev. 2021; 3:CD013119. PMC: 8094234. DOI: 10.1002/14651858.CD013119.pub2. View

18.

Rozier M, Ghaferi A, Rose A, Simon N, Birkmeyer N, Prosser L . Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment. Surg Obes Relat Dis. 2020; 16(6):738-744. DOI: 10.1016/j.soard.2020.02.005. View

19.

Gronroos S, Helmio M, Juuti A, Tiusanen R, Hurme S, Loyttyniemi E . Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss and Quality of Life at 7 Years in Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA Surg. 2020; 156(2):137-146. PMC: 7726698. DOI: 10.1001/jamasurg.2020.5666. View

20.

Khalaj A, Tasdighi E, Hosseinpanah F, Mahdavi M, Valizadeh M, Farahmand E . Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC Surg. 2020; 20(1):160. PMC: 7370506. DOI: 10.1186/s12893-020-00819-3. View