Advertisement

Obesity Surgery

, Volume 23, Issue 12, pp 2004–2012 | Cite as

Early Post-operative Complications: Incidence, Management, and Impact on Length of Hospital Stay. A Retrospective Comparison Between Laparoscopic Gastric Bypass and Sleeve Gastrectomy

  • Rudolf A. Weiner
  • Islam A. El-Sayes
  • Sophia Theodoridou
  • Sylvia R. Weiner
  • Oliver Scheffel
Original Contributions

Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common obesity surgeries. Their early complications may prolong hospital stay (HS).

Methods

Data for patients who underwent LRYGB and LSG in our clinic from 2009 through August 2012 were collected. Early post-operative complications prolonging HS (>5 days) were retrospectively analyzed, highlighting their relative incidence, management, and impact on length of HS.

Results

Sixty-six patients (4.9 %) after 1,345 LRYGB operations vs. 49 patients (7.14 %) after 686 LSG operations developed early complications. This difference is statistically significant (p = 0.039). Male gender percentage was significantly higher in complicated LSG group vs. complicated LRYGB group [23 patients (46.9 %) vs. 16 patients (24.2 %)] (p = 0.042). Mean BMI was significantly higher in the complicated LSG group (54.2 ± 8.3) vs. complicated LRYGB group (46.8 ± 5.7; p = 0.004). Median length of HS was not longer after complicated LSG compared with complicated LRYGB (11 vs. 10 days; p = 0.287). Leakage and bleeding were the most common complications after either procedure. Leakage rate was not higher after LSG (12 patients, 1.7 %) compared with LRYGB (22 patients, 1.6 %; p = 0.304). Bleeding rate was significantly higher after LSG (19 patients, 2.7 %) than after LRYGB (10 patients, 0.7 %; p = 0.004). Prolonged elevation of inflammatory markers was the most common presentation for complications after LSG (18 patients, 36.7 %) and LRYGB (31 patients, 46.9 %).

Conclusions

LSG was associated with more early complications. This may be attributed to higher BMI and predominance of males in LSG group.

Keywords

Laparoscopic Roux-en-Y gastric bypass Laparoscopic sleeve gastrectomy Length of hospital stay Early post-operative complications Leakage Bleeding 

Notes

Conflict of Interest

None.

References

  1. 1.
    Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24:1005–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Gagner M, Deitel M, Kalberer T, et al. The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Santry H, Gillen D, Lauderdale D. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Griffith P, Birch D, Sharma A, et al. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity. Can J Surg. 2012;55:329–36.PubMedCrossRefGoogle Scholar
  8. 8.
    NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  9. 9.
    Runkel N, Colombo-Benkmann M, Hüttl T, et al. Evidence-based German guidelines for surgery for obesity. Int J Colorectal Dis. 2011;26:397–404.PubMedCrossRefGoogle Scholar
  10. 10.
    Stroh C, Luderer D, Weiner R, et al. Actual situation of thromboembolic prophylaxis in obesity surgery: data of quality assurance in bariatric surgery in Germany. Thrombosis. 2012. doi: 10.1155/2012/209052.
  11. 11.
    American Society for Metabolic and Bariatric Surgery (2009) www.asmbs.org/Newsite07/media/ASMBS_Metabolic_Bariatric_Surgery_Overview_FINAL_09.pdf. Accessed 23 March 2011
  12. 12.
    Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.PubMedCrossRefGoogle Scholar
  14. 14.
    Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity. Exp Rev Med Devices. 2006;3:105–12.CrossRefGoogle Scholar
  15. 15.
    Lancaster R, Hutter M. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multicenter, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22:2554–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Dallal R, Datta T, Braitman L. Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery. Surg Obes Relat Dis. 2007;3:592–6.PubMedCrossRefGoogle Scholar
  17. 17.
    McCarty T, Arnold D, Lamont J, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–501.PubMedGoogle Scholar
  18. 18.
    Benotti P, Wood G, Winegar D, et al. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2013. doi: 10.1097/SLA.0b013e31828a0ee4.
  19. 19.
    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Morais A, Faintuch J, Leal A, et al. Inflammation and biochemical features of bariatric candidates: does gender matter? Obes Surg. 2011;21:71–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Stroh C, Köckerling F, Weiner R, et al. Are there gender-specific aspects of sleeve gastrectomy—data analysis from the quality assurance study of surgical treatment of obesity in Germany. Obes Surg. 2012;22:1214–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Inabnet W, Belle S, Bessler M, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2010;6:22–30.PubMedCrossRefGoogle Scholar
  23. 23.
    LABS Consortium Writing Group. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. New Engl J Med. 2009;361:445–54.CrossRefGoogle Scholar
  24. 24.
    Skroubis G, Karamanakos S, Sakellaropoulos G, et al. Comparison of early and late complications after various bariatric procedures: incidence and treatment during 15 years at a single institution. World J Surg. 2011;35:93–101.PubMedCrossRefGoogle Scholar
  25. 25.
    Fernandez A, DeMaria E, Tichansky D, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18:193–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Marshall J, Srivastava A, Gupta SK, et al. Roux-en-Y gastric bypass leak complications. Arch Surg. 2003;138:520–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Bellorin O, Abdemur A, Sucandy I, et al. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg. 2011;21:707–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Fullum T, Aluka K, Turner P. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23:1403–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Madan A, Martinez J, Menzo E, et al. Omental reinforcement for intraoperative leak repairs during laparoscopic Roux-en-Y gastric bypass. Am Surg. 2009;75:839–42.PubMedGoogle Scholar
  30. 30.
    Ballesta C, Berindoague R, Cabrera M, et al. Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:623–30.PubMedCrossRefGoogle Scholar
  31. 31.
    Attila Csendes A, Burgos A, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22:855–62.PubMedCrossRefGoogle Scholar
  32. 32.
    Deitel M, Gagner M, Erickson A, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.PubMedCrossRefGoogle Scholar
  33. 33.
    Herron D, Roohipour R. Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging. 2012;37:712–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Warschkow R, Tarantino I, Folie P. C-Reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg. 2012;16:1128–35.PubMedCrossRefGoogle Scholar
  35. 35.
    Kolakowski S, Kirkland M, Schuricht A. Routine postoperative upper gastrointestinal series after Roux-en-Y gastric by pass: determination of whether it is necessary. Arch Surg. 2007;142:930–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Yu J, Turner M, Cho S, et al. Normal anatomy and complications after gastric bypass surgery: helical CT findings. Radiology. 2004;231:753–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Blackmon S, Santora R, Schwarz P, et al. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89:931–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Tan J, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:403–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Bakhos C, Alkhoury F, Kyriakides T, et al. Early post-operative hemorrhage after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;2:153–577.CrossRefGoogle Scholar
  41. 41.
    Schauer P, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.PubMedCrossRefGoogle Scholar
  42. 42.
    Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21:473–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Kothari S. Bariatric surgery and postoperative imaging. Surg Clin N Am. 2011;91:155–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Sajid M, Khatri K, Singh K, et al. Use of staple-line reinforcement in laparoscopic gastric bypass surgery: a meta-analysis. Surg Endosc. 2011;25:2884–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Consten E, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14:1360–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Giannopoulos G, Tzanakis N, Rallis G, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc. 2010;24:2782–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Daskalakis M, Berdan Y, Theodoridou S, et al. Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy. Surg Endosc. 2011;25:88–97.PubMedCrossRefGoogle Scholar
  48. 48.
    Chiu C, Lee W, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16:913–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Brethauer S, Schauer P. Risk–benefit analysis of laparoscopic bariatric procedures. In: Schauer P, Schirmer B, Brethauer S, editors. Minimally invasive bariatric surgery. New York: Springer; 2007. p. 371.Google Scholar
  50. 50.
    Hutter M, Schirmer B, Jones D, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254:410–22.PubMedCrossRefGoogle Scholar
  51. 51.
    Birkmeyer N, Dimick J, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304:435–42.PubMedCrossRefGoogle Scholar
  52. 52.
    DeMaria E, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6:347–55.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rudolf A. Weiner
    • 1
  • Islam A. El-Sayes
    • 1
  • Sophia Theodoridou
    • 1
  • Sylvia R. Weiner
    • 1
  • Oliver Scheffel
    • 1
  1. 1.Surgery DepartmentSachsenhausen HospitalFrankfurt am MainGermany

Personalised recommendations