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Propensity Score Matching Sleeve Gastrectomy vs. Gastric Bypass with 5 Years of Follow-Up

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Abstract

Purpose

Beginning January 1, 2005, bariatric surgery cases were examined with the help of the quality assurance study for operative medicine. All data were registered and analyzed prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg, Germany. The comparative study focuses on perioperative morbidity, complications, and remission of obesity-associated diseases after gastric bypass (RYGB) and sleeve gastrectomy (SG) at 5-year follow-up.

Materials and Methods

Data collection includes patients of full age who underwent SG or RYGB surgery between 2005 and 2017. The bougie is limited to 33–40 French for SG. The Roux-en-Y length for RYGB is set to 120–180 cm, and the biliodigestive length is set to 40–60 cm. Outcome criteria are perioperative morbidity, postoperative and intraoperative complications, and remission on comorbidities.

Results

Between 2005 and 2017, 64,349 patients were enrolled in German Bariatric Surgery Registry (GBSR). Primary operations that were performed were 56.328. Out of 24,146 RYGB and 24,085 SG procedures, 922 patients had a complete 5-year follow-up. These are 342 SG patients and 580 patients with RYGB. A matching was realized for n = 285 (83.3%) patient pairs based on age, BMI, gender, ASA, and comorbidities. A significant disadvantage was identified for the SG procedure regarding reflux disease compared with RYGB (36.3% vs. 8.10%; p < 0.001). There were no significant disadvantages in terms of BMI reduction [14.92 in the RYGB and 14.50 in the SG (p = 0.437)] and %EWL [60.32 in the RYGB and 58.98 in the SG (p = 0.504)]. This also applies to the remission of NIDDM, IDDM, hypertension, and sleep apnea; no significant differences were found.

Conclusion

The results of the study show significant findings for gastroesophageal reflux. In terms of complications and obesity-associated diseases, no significant disadvantages between both treatments were found. RYGB and SG had comparable postoperative morbidity rates. The two surgical methods are legitimate bariatric procedures. However, there is a need for further evaluation to optimize patient selection in the coming years.

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Acknowledgements

We would like to thank Mr. Hukauf for his contributions to the statistical analysis of our data. We thank all hospitals participating in the study for their active engagement.

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Authors and Affiliations

  1. Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring, 40, 44625, Herne, Germany

    Omar Thaher

  2. StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany

    Martin Hukauf

  3. Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany

    Christine Stroh

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  1. Omar Thaher
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  3. Christine Stroh
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Correspondence to Christine Stroh.

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Ethical Approval

For this type of retrospective study, no formal consent was required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Key Points

• Sleeve gastrectomy and gastric bypass achieved identical results in terms of peri- and postoperative complications.

• Reflux within 5 years after surgery was four times higher after SG than after RYGB.

• No significant difference between SG and RYGB in terms of remission of obesity-associated diseases

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Thaher, O., Hukauf, M. & Stroh, C. Propensity Score Matching Sleeve Gastrectomy vs. Gastric Bypass with 5 Years of Follow-Up. OBES SURG 31, 5156–5165 (2021). https://doi.org/10.1007/s11695-021-05706-1

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