A Retrospective 2-Year Follow-up of Late Complications Treated Surgically and Endoscopically After Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) for Morbid Obesity
The laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the gold standard for bariatric surgery, but recently, the laparoscopic sleeve gastrectomy (LSG) has gained popularity. At present, limited data is available on the long-term complications of these two types of surgery. The aim of this retrospective study was to compare the 2-year data about late (more than 30 days after surgery) complications that were treated surgically or endoscopically after LRYGB and LSG operations in a large hospital area with a single patient database.
This was a retrospective, non-randomized, single-center study of 760 (545 LRYGB and 215 LSG) bariatric patients surgically treated between 2008 and 2013 in the Bariatric Surgery Unit of Helsinki University Central Hospital.
The patients were followed for 2 years, and late complications (more than 30 days after surgery) that were surgically and/or endoscopically treated were registered. Weight loss and the risk factors for complications were also monitored.
The study found a difference between the LRYGB and LSG patients in a number of late complications treated by both intervention types: surgical intervention were required in 9.4% of LRYGB patients vs. 0.9 of LSG patients, and endoscopic intervention were required by 4.6% of LRYGB patients vs. 1.4% of LSG patients (both p < 0.05). The risk of surgical complications was increased by better weight loss results in 12 months.
LRYGB was found to be associated with a greater risk of late complications. If larger databases confirm these results, the trend toward LSG is justified.
KeywordsBariatric surgery Late complications LSG LRYGB
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest or any disclosure to mention.
Informed consent was obtained from all individual participants included in the study.
- 1.Walsh C, Karmali S. Endoscopic management of bariatric complications: a review and update. World J Gastrointest Endosc.7(5).Google Scholar
- 2.Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States, 2000. JAMA. 293(3).Google Scholar
- 3.Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg. 25(10).Google Scholar
- 4.Kruger RS, Pricolo VE, Streeter TT, Colacchio DA, Andrade UA. A bariatric surgery center of excellence: operative trends and long-term outcomes. J Am Coll Surg. 218(6).Google Scholar
- 5.Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. (8):CD003641.Google Scholar
- 6.Zak Y, Petrusa E, Gee DW. Laparoscopic Roux-en-Y gastric bypass patients have an increased lifetime risk of repeat operations when compared to laparoscopic sleeve gastrectomy patients. Surg Endosc. 30(5).Google Scholar
- 7.Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and outcomes of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass: analysis of the American College of Surgeons NSQIP. J Am Coll Surg. 220(5).Google Scholar
- 8.Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres AJ, Weiner R, Yashkov Y, Fruhbeck G et al. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts. 6(5).Google Scholar
- 9.Helmio M, Victorzon M, Ovaska J, Leivonen M, Juuti A, Jaser N, Peromaa P, Tolonen P, Hurme S, Salminen P. SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg Endosc. 26(9).Google Scholar
- 10.Al-Mansour MR, Mundy R, Canoy JM, Dulaimy K, Kuhn JN, Romanelli J. Internal hernia after laparoscopic antecolic Roux-en-Y gastric bypass. Obes Surg. 25(11).Google Scholar
- 11.Geubbels N, Lijftogt N, Fiocco M, van Leersum NJ, Wouters MW, de Brauw LM. Meta-analysis of internal herniation after gastric bypass surgery. Br J Surg. 102(5).Google Scholar
- 12.Paroz A, Calmes JM, Giusti V, Suter M. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg. 16(11).Google Scholar
- 13.Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, Serletti JM, Kovach SJ. A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg. 263(5).Google Scholar
- 14.Basta MN, Mirzabeigi MN, Shubinets V, Kelz RR, Williams NN, Fischer JP. Predicting incisional hernia after bariatric surgery: a risk stratification model based upon 2161 operations. Surg Obes Relat Dis. 12(8).Google Scholar
- 15.Coblijn UK, de Raaff CA, van Wagensveld BA, van Tets WF, de Castro SM. Trocar port hernias after bariatric surgery. Obes Surg. 26(3).Google Scholar
- 16.Pitt T, Brethauer S, Sherman V, Udomsawaengsup S, Metz M, Chikunguwo S, Chand B, Schauer P. Diagnostic laparoscopy for chronic abdominal pain after gastric bypass. Surg Obes Relat Dis. 4(3).Google Scholar
- 17.Greenstein AJ, O'Rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg. 201(6).Google Scholar
- 18.Ramaswamy A, Lin E, Ramshaw BJ, Smith CD. Early effects of Helicobacter pylori infection in patients undergoing bariatric surgery. Arch Surg. 139(10).Google Scholar
- 19.Azagury DE, Abu Dayyeh BK, Greenwalt IT, Thompson CC. Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes. Endoscopy. 43(11).Google Scholar
- 20.Joo MK. Endoscopic approach for major complications of bariatric surgery. Clin Endosc. 50(1).Google Scholar
- 21.Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol. 12(12).Google Scholar
- 22.Filho AJ, Kondo W, Nassif LS, Garcia MJ, Tirapelle Rde A, Dotti CM. Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass. JSLS. 10(3).Google Scholar
- 23.Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, Bernstine H, Singer P, Dickman R, Beglaibter N, Shikora SA, Rosenthal RJ, Rubin M. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8Google Scholar
- 24.Kothari TH, Haber G, Sonpal N, Karanth N. The over-the-scope clip system—a novel technique for gastrocutaneous fistula closure: the first North American experience. Can J Gastroenterol. 26(4).Google Scholar
- 25.Donatelli G, Dumont JL, Cereatti F, Ferretti S, Vergeau BM, Tuszynski T, Pourcher G, Tranchart H, Mariani P, Meduri A, Catheline JM, Dagher I, Fiocca F, Marmuse JP, Meduri B. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 25(7).Google Scholar
- 26.Chang J, Corcelles R, Boules M, Jamal MH, Schauer PR, Kroh MD. Predictive factors of biliary complications after bariatric surgery. Surg Obes Relat Dis. 12(9).Google Scholar
- 27.Moon RC, Teixeira AF, DuCoin C, Varnadore S, Jawad MA. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 10(1).Google Scholar
- 28.Osland E, Yunus RM, Khan S, Memon B, Memon MA. Late postoperative complications in laparoscopic sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-y gastric bypass (LRYGB): meta-analysis and systematic review. Surg Laparosc Endosc Percutan Tech. 26(3).Google Scholar
- 29.Ochner CN, Jochner MC, Caruso EA, Teixeira J, Xavier Pi-Sunyer F. Effect of preoperative body mass index on weight loss after obesity surgery. Surg Obes Relat Dis. 9(3).Google Scholar
- 30.Schneider C, Cobb W, Scott J, Carbonell A, Myers K, Bour E. Rapid excess weight loss following laparoscopic gastric bypass leads to increased risk of internal hernia. Surg Endosc. 25(5).Google Scholar