Laparoscopic Roux-Y gastric bypass (LRYGBP) is the gold-standard procedure for the treatment of morbid obesity. It has been reported to be somewhat more efficient and durable than laparoscopic sleeve gastrectomy (LSG). However, it is considered more invasive and, therefore, more hazardous. There is a lack of unity in complication reporting following bariatric surgery. Thus, there is a possible misconception regarding the relative safety of the two major bariatric procedures performed worldwide. This may have contributed to a shift in practice with LSG gaining momentum “at the expense” of LRYGBP. The aim of this study was to evaluate the relative safety of primary LSG and LRYGBP according to the Clavien–Dindo complication grading system.
A total of 2651 and 554 patients underwent primary LSG and LRYGBP, respectively at three high-volume centers. Thirty-day perioperative complications were recorded and graded. Length of hospital stays (LOS) and readmission rates were collected as well.
Complications occurred in 110 (3.7 %) and 24 (4.3 %) patients following LSG and LRYGBP, respectively (p = 0.9). No significant difference was found between the groups regarding overall and complication-grade-specific rates. Individual complication types were unevenly distributed, but not significantly so. Patients with complications were older than those without (47 and 43 years, respectively; p = 0.01). Gender was not a risk factor for complication. Median LOS and readmission rates were not significantly different.
LSG and LRYGBP are equally safe, at least in the perioperative period. Acknowledging and conveying this finding to surgeons and patients alike is important and might cause a pendulum shift in the distribution of bariatric procedures performed.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Robinson MK (2009) Surgical treatment of obesity–weighing the facts. N Engl J Med 361:520–521
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(248–256):e245
Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N (2007) Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg 246:1002–1007 discussion 1007–1009
Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE (2004) The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 240:586–593 discussion 593–584
Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ (2013) Surgical skill and complication rates after bariatric surgery. N Engl J Med 369:1434–1442
Encinosa WE, Bernard DM, Du D, Steiner CA (2009) Recent improvements in bariatric surgery outcomes. Med Care 47:531–535
Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454
Becattini C, Agnelli G, Manina G, Noya G, Rondelli F (2012) Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention. Surg Obes Relat Dis 8:108–115
Rocha AT, de Vasconcellos AG, da Luz Neto ER, Araujo DM, Alves ES, Lopes AA (2006) Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg 16:1645–1655
Goitein D, Matter I, Raziel A, Keidar A, Hazzan D, Rimon U, Sakran N (2013) Portomesenteric thrombosis following laparoscopic bariatric surgery: incidence, patterns of clinical presentation, and etiology in a bariatric patient population. JAMA Surg 148:340–346
Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, Matter I, Alfici R, Mahajna A, Waksman I, Shimonov M, Assalia A (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27:240–245
Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436
Nguyen NT, Nguyen B, Gebhart A, Hohmann S (2013) Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg 216:252–257
Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB (2014) Changes in bariatric surgery procedure use in Michigan, 2006–2013. JAMA 312:959–961
Lazzati A, Guy-Lachuer R, Delaunay V, Szwarcensztein K, Azoulay D (2013) Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis 10:328–334
Weinstein AL, Marascalchi BJ, Spiegel MA, Saunders JK, Fagerlin A, Parikh M (2014) Patient preferences and bariatric surgery procedure selection; the need for shared decision-making. Obes Surg 24:1933–1939
Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN (2014) Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 208:903–910
Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366:1567–1576
Albeladi B, Bourbao-Tournois C, Huten N (2013) Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity. J Obes 2013:934653
Leyba JL, Aulestia SN, Llopis SN (2011) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients. Obes Surg 21:212–216
Vidal P, Ramon JM, Goday A, Benaiges D, Trillo L, Parri A, Gonzalez S, Pera M, Grande L (2013) Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results. Obes Surg 23:292–299
Peterli R, Borbely Y, Kern B, Gass M, Peters T, Thurnheer M, Schultes B, Laederach K, Bueter M, Schiesser M (2013) Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 258:690–694 discussion 695
Topart P, Becouarn G, Ritz P (2011) Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 8:250–254
Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, Drewe J, von Flue M, Beglinger C (2009) Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg 250:234–241
Leyba JL, Llopis SN, Aulestia SN (2014) Laparoscopic Roux-en-Y Gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study with 5 years of follow-up. Obes Surg 24:2094–2098
Sieber P, Gass M, Kern B, Peters T, Slawik M, Peterli R (2014) Five-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 10:243–249
Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT (2003) Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 138:957–961
Goitein D, Feigin A, Segal-Lieberman G, Goitein O, Papa MZ, Zippel D (2011) Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc 25:2626–2630
Rosenthal RJ, Szomstein S, Kennedy CI, Soto FC, Zundel N (2006) Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. Obes Surg 16:119–124
Ben Yaacov A, Sadot E, Ben David M, Wasserberg N, Keidar A (2014) Laparoscopic total gastrectomy with Roux-Y esophagojejunostomy for chronic gastric fistula after laparoscopic sleeve gastrectomy. Obes Surg 24:425–429
Iannelli A, Tavana R, Martini F, Noel P, Gugenheim J (2014) Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obes Surg 24:825–828
Vilallonga R, Himpens J, van de Vrande S (2014) Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects. Surg Endosc 29:414–416
Martin-Malagon A, Rodriguez-Ballester L, Arteaga-Gonzalez I (2011) Total gastrectomy for failed treatment with endotherapy of chronic gastrocutaneous fistula after sleeve gastrectomy. Surg Obes Relat Dis 7:240–242
Drs. D. Goitein, A. Raziel, A. Szold and N. Sakran have no conflict of interest to disclose.
About this article
Cite this article
Goitein, D., Raziel, A., Szold, A. et al. Assessment of perioperative complications following primary bariatric surgery according to the Clavien–Dindo classification: comparison of sleeve gastrectomy and Roux-Y gastric bypass. Surg Endosc 30, 273–278 (2016). https://doi.org/10.1007/s00464-015-4205-y
- Sleeve gastrectomy
- Gastric bypass
- Clavien–Dindo classification