Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Angrisani L, Santonicola A, Iovino P et al (2018) IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 28(12):3783–3794. https://doi.org/10.1007/s11695-018-3450-2

    Article  PubMed  Google Scholar 

  2. Alalwan AA, Friedman J, Park H, Segal R, Brumback BA, Hartzema AG (2021) US national trends in bariatric surgery: a decade of study. Surgery 170(1):13–17. https://doi.org/10.1016/j.surg.2021.02.002

    Article  PubMed  Google Scholar 

  3. Guraya SY, Strate T (2020) 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 26(8):865–876. https://doi.org/10.3748/wjg.v26.i8.865

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mechanick JI, Apovian C, Brethauer S et al (2019) Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures & #x2013; 2019 update: cosponsored by American association of clinical endocrinologists/American college of endocri. Endocr Pract 25:1–75. https://doi.org/10.4158/GL-2019-0406

    Article  Google Scholar 

  5. Peterli R, Wölnerhanssen BK, Peters T et al (2018) 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 319(3):255–265. https://doi.org/10.1001/jama.2017.20897

    Article  PubMed  PubMed Central  Google Scholar 

  6. Andalib A, Alamri H, Almuhanna Y, Bouchard P, Demyttenaere S, Court O (2021) 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 35(8):4644–4652. https://doi.org/10.1007/s00464-020-07891-z

    Article  PubMed  Google Scholar 

  7. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014(8):CD003641. https://doi.org/10.1002/14651858.CD003641.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA (2013) Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg 23(11):1766–1773. https://doi.org/10.1007/s11695-013-1012-1

    Article  PubMed  Google Scholar 

  9. Clapp B, Wynn M, Martyn C, Foster C, O’Dell M, Tyroch A (2018) Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis 14(6):741–747. https://doi.org/10.1016/j.soard.2018.02.027

    Article  PubMed  Google Scholar 

  10. Andalib A, Aminian A, Khorgami Z, Navaneethan SD, Schauer PR, Brethauer SA (2016) Safety analysis of primary bariatric surgery in patients on chronic dialysis. Surg Endosc 30(6):2583–2591. https://doi.org/10.1007/s00464-015-4530-1

    Article  PubMed  Google Scholar 

  11. Andalib A, Aminian A, Khorgami Z et al (2016) Early postoperative outcomes of primary bariatric surgery in patients on chronic steroid or immunosuppressive therapy. Obes Surg 26(7):1479–1486. https://doi.org/10.1007/s11695-015-1923-0

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. American Society for Metabolic and Bariatric Surgery Insurance Committee (2013) CPT® and ICD-9 Codes for Bariatric Surgery. https://asmbs.org/app/uploads/2012/01/1CPTandICD-9-Codes-for-Bariatric-Surgery-updated-Feb-2013d.pdf.

  14. Brethauer SA, Kim J, el Chaar M et al (2015) Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 11(3):489–506. https://doi.org/10.1016/j.soard.2015.02.003

    Article  Google Scholar 

  15. Ban KA, Minei JP, Laronga C et al (2017) American college of surgeons and surgical infection society: surgical site infection guidelines, 2016 update. J Am Coll Surg 224(1):59–74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029

    Article  PubMed  Google Scholar 

  16. Berríos-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152(8):784–791. https://doi.org/10.1001/jamasurg.2017.0904

    Article  PubMed  Google Scholar 

  17. Macefield RC, Reeves BC, Milne TK et al (2017) Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion. J Infect Prev 18(4):170–179. https://doi.org/10.1177/1757177416689724

    Article  PubMed  PubMed Central  Google Scholar 

  18. Stone PW (2009) Changes in Medicare reimbursement for hospital-acquired conditions including infections. Am J Infect Control 37(9):A17–A18. https://doi.org/10.1016/j.ajic.2009.07.001

    Article  PubMed  Google Scholar 

  19. Magill SS, Edwards JR, Bamberg W et al (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370(13):1198–1208. https://doi.org/10.1056/NEJMoa1306801

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Conley MM, McFarlane CM, Johnson DW, Kelly JT, Campbell KL, MacLaughlin HL (2021) Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database Syst Rev. 3(3):CD013119. https://doi.org/10.1002/14651858.CD013119.pub2

    Article  PubMed  Google Scholar 

  21. Rozier MD, Ghaferi AA, Rose AM, Simon N-J, Birkmeyer NJ, Prosser LA (2020) Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment. Surg Obes Relat Dis 16(6):738–744. https://doi.org/10.1016/j.soard.2020.02.005

    Article  PubMed  Google Scholar 

  22. Grönroos S, Helmiö M, Juuti A et al (2021) 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 156(2):137–146. https://doi.org/10.1001/jamasurg.2020.5666

    Article  PubMed  Google Scholar 

  23. Khalaj A, Tasdighi E, Hosseinpanah F et al (2020) Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC Surg 20(1):160. https://doi.org/10.1186/s12893-020-00819-3

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kumar SB, Hamilton BC, Wood SG, Rogers SJ, Carter JT, Lin MY (2018) Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis 14(3):264–269. https://doi.org/10.1016/j.soard.2017.12.011

    Article  PubMed  Google Scholar 

  25. El CM, Lundberg P, Stoltzfus J (2018) Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on metabolic and bariatric surgery accreditation and quality improvement program database. Surg Obes Relat Dis 14(5):545–551. https://doi.org/10.1016/j.soard.2018.01.011

    Article  Google Scholar 

  26. Kapur A, Thodiyil P (2021) Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes. Surg Obes Relat Dis 17(7):1369–1382. https://doi.org/10.1016/j.soard.2021.01.022

    Article  PubMed  Google Scholar 

  27. Fridman A, Moon R, Cozacov Y et al (2013) Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American college of surgeons bariatric surgery centers of excellence. J Am Coll Surg 217(4):614–620. https://doi.org/10.1016/j.jamcollsurg.2013.05.013

    Article  PubMed  Google Scholar 

  28. Thereaux J, Corigliano N, Poitou C, Oppert J-M, Czernichow S, Bouillot J-L (2015) Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI≥50 kg/m2. Surg Obes Relat Dis 11(4):785–790. https://doi.org/10.1016/j.soard.2014.11.022

    Article  PubMed  Google Scholar 

  29. Jalilvand A, Levene KA, Shah K, Needleman B, Noria SF (2021) Characterization of urgent versus nonurgent early readmissions (<30 days) following primary bariatric surgery: a single-institution experience. Surg Obes Relat Dis 17(5):921–930. https://doi.org/10.1016/j.soard.2021.01.042

    Article  PubMed  Google Scholar 

  30. Clapp B, Harper B, Dodoo C et al (2020) Trends in revisional bariatric surgery using the MBSAQIP database 2015–2017. Surg Obes Relat Dis 16(7):908–915. https://doi.org/10.1016/j.soard.2020.03.002

    Article  PubMed  Google Scholar 

  31. Mahawar KK, Nimeri A, Adamo M et al (2018) Practices concerning revisional bariatric surgery: a survey of 460 surgeons. Obes Surg 28(9):2650–2660. https://doi.org/10.1007/s11695-018-3226-8

    Article  PubMed  Google Scholar 

  32. Landreneau JP, Strong AT, Rodriguez JH et al (2018) Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg 28(12):3843–3850. https://doi.org/10.1007/s11695-018-3435-1

    Article  PubMed  Google Scholar 

  33. Alexandrou A, Sakarellos P, Davakis S et al (2022) Revision of Roux-en-Y gastric bypass for inadequate weight loss or weight regain. In Vivo 36(1):30–39. https://doi.org/10.21873/invivo.12673

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rayman S, Staierman M, Ben-David M et al (2020) Laparoscopic revision to total gastrectomy or fistulo-jejunostomy as a definitive surgical procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 16(12):1893–1900. https://doi.org/10.1016/j.soard.2020.07.035

    Article  Google Scholar 

  35. Poghosyan T, Alameh A, Bruzzi M et al (2019) Conversion of sleeve gastrectomy to one anastomosis gastric bypass for weight loss failure. Obes Surg 29(8):2436–2441. https://doi.org/10.1007/s11695-019-03864-x

    Article  PubMed  Google Scholar 

  36. Lee Y, Ellenbogen Y, Doumouras AG, Gmora S, Anvari M, Hong D (2019) Single- or double-anastomosis duodenal switch versus Roux-en-Y gastric bypass as a revisional procedure for sleeve gastrectomy: a systematic review and meta-analysis. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 15(4):556–566. https://doi.org/10.1016/j.soard.2019.01.022

    Article  Google Scholar 

  37. Yeo C, Ho G, Syn N et al (2021) Revisional one-anastomosis gastric bypass after restrictive index surgery-a metaanalysis and comparison with revisional Roux-en-Y gastric bypass. Obes Surg 31(3):949–964. https://doi.org/10.1007/s11695-020-05094-y

    Article  PubMed  Google Scholar 

  38. Yeung L, Durkan B, Barrett A et al (2016) Single-stage revision from gastric band to gastric bypass or sleeve gastrectomy: 6- and 12-month outcomes. Surg Endosc 30(6):2244–2250. https://doi.org/10.1007/s00464-015-4498-x

    Article  PubMed  Google Scholar 

  39. Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D (2013) Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc 27(3):740–745. https://doi.org/10.1007/s00464-012-2510-2

    Article  PubMed  Google Scholar 

  40. Fernando Santos B, Wallaert JB, Trus TL (2014) Band removal and conversion to sleeve or bypass: are they equally safe? Surg Endosc 28(11):3086–3091. https://doi.org/10.1007/s00464-014-3584-9

    Article  CAS  PubMed  Google Scholar 

  41. Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Sioka E, Zacharoulis D (2017) Roux-en-Y gastric bypass versus sleeve gastrectomy as revisional procedure after adjustable gastric band: a systematic review and meta-analysis. Obes Surg 27(5):1365–1373. https://doi.org/10.1007/s11695-017-2644-3

    Article  PubMed  Google Scholar 

  42. Zhou R, Poirier J, Torquati A, Omotosho P (2019) Short-term outcomes of conversion of failed gastric banding to laparoscopic sleeve gastrectomy or Roux-En-Y gastric bypass: a meta-analysis. Obes Surg 29(2):420–425. https://doi.org/10.1007/s11695-018-3538-8

    Article  PubMed  Google Scholar 

  43. Pędziwiatr M, Małczak P, Wierdak M et al (2018) Revisional gastric bypass is inferior to primary gastric bypass in terms of short- and long-term outcomes-systematic review and meta-analysis. Obes Surg 28(7):2083–2091. https://doi.org/10.1007/s11695-018-3300-2

    Article  PubMed  PubMed Central  Google Scholar 

  44. Elshaer M, Hamaoui K, Rezai P, Ahmed K, Mothojakan N, Al-Taan O (2019) Secondary bariatric procedures in a high-volume centre: prevalence. Indications Outcomes Obes Surg 29(7):2255–2262. https://doi.org/10.1007/s11695-019-03838-z

    Article  PubMed  Google Scholar 

  45. Cheung D, Switzer NJ, Gill RS, Shi X, Karmali S (2014) Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg 24(10):1757–1763. https://doi.org/10.1007/s11695-014-1332-9

    Article  PubMed  Google Scholar 

  46. Braga JGR, Concon MM, Lima AP et al (2021) Revisional surgery in severe nutritional complications after bariatric surgical procedures: report of four cases from a single institution and review of the literature. Rev Col Bras Cir 48:e20202666. https://doi.org/10.1590/0100-6991e-20202666

    Article  PubMed  Google Scholar 

  47. Frantzides CT, Alexander B, Frantzides AT (2019) Laparoscopic revision of failed bariatric procedures. JSLS J Soc Laparoendosc Surg. https://doi.org/10.4293/JSLS.2018.00074

    Article  Google Scholar 

  48. Cheng H, Clymer JW, Po-Han Chen B et al (2018) Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 229:134–144. https://doi.org/10.1016/j.jss.2018.03.022

    Article  PubMed  Google Scholar 

  49. Reames BN, Bacal D, Krell RW, Birkmeyer JD, Birkmeyer NJO, Finks JF (2015) Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 11(1):207–213. https://doi.org/10.1016/j.soard.2014.03.018

    Article  Google Scholar 

  50. Dang JT, Switzer NJ, Wu J et al (2016) Gastric band removal in revisional bariatric surgery, one-step versus two-step: a systematic review and meta-analysis. Obes Surg 26(4):866–873. https://doi.org/10.1007/s11695-016-2082-7

    Article  PubMed  Google Scholar 

  51. DeMaria EJ, Sugerman HJ, Meador JG et al (2001) High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 233(6):809–818. https://doi.org/10.1097/00000658-200106000-00011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Altieri MS, Yang J, Nie L, Blackstone R, Spaniolas K, Pryor A (2018) Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis 14(4):500–507. https://doi.org/10.1016/j.soard.2017.12.019

    Article  PubMed  Google Scholar 

  53. Altieri MS, Yang J, Groves D et al (2018) Sleeve Gastrectomy: the first 3 years: evaluation of emergency department visits, readmissions, and reoperations for 14,080 patients in New York State. Surg Endosc 32(3):1209–1214. https://doi.org/10.1007/s00464-017-5793-5

    Article  PubMed  Google Scholar 

  54. Vanetta C, Dreifuss NH, Schlottmann F, Baz C, Masrur MA (2022) Bariatric surgery conversions in MBSAQIP centers: current indications and outcomes. Obes Surg. https://doi.org/10.1007/s11695-022-06229-z

    Article  PubMed  PubMed Central  Google Scholar 

  55. Michalsky M, Reichard K, Inge T, Pratt J, Lenders C (2012) ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 8(1):1–7. https://doi.org/10.1016/j.soard.2011.09.009

    Article  Google Scholar 

  56. El Chaar M, King K, Al-Mardini A, Galvez A, Claros L, Stoltzfus J (2021) Thirty-day outcomes of bariatric surgery in adolescents: a first look at the MBSAQIP database. Obes Surg 31(1):194–199. https://doi.org/10.1007/s11695-020-04866-w

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authorship team would like to thank Drs. Mya Roberson and Paula Strassle for their assistance with statistical analysis and S. Jordan Chadwick for her assistance in proofreading the final manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA

    William C. Bennett, Ian C. Garbarine, Murphy Mostellar, Jeffrey Lipman, Manuel Sanchez-Casalongue, Timothy Farrell & Randal Zhou

  2. Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    William C. Bennett

  3. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ian C. Garbarine

  4. Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA

    Jeffrey Lipman

  5. Hernia Center, NYC Health + Hospitals / Bellevue, New York, NY, USA

    Jeffrey Lipman

  6. Rush Copley Medical Center, Rush University, Aurora, IL, USA

    Manuel Sanchez-Casalongue

  7. Division of Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA

    Randal Zhou

Authors
  1. William C. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ian C. Garbarine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murphy Mostellar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Lipman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manuel Sanchez-Casalongue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timothy Farrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Randal Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William C. Bennett.

Ethics declarations

Disclosures

William C. Bennett, Ian C. Garbarine, Murphy Mostellar, Jeffrey Lipman, Manuel Sanchez-Casalongue, Timothy Farrell, and Randal Zhou have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bennett, W.C., Garbarine, I.C., Mostellar, M. et al. 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. Surg Endosc 37, 3728–3738 (2023). https://doi.org/10.1007/s00464-022-09796-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09796-5

Keywords

Search

Navigation