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Comparison of early outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy among patients with body mass index ≥ 60 kg/m2

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

There is no consensus on the ideal bariatric operation to choose for patients with extremely high body mass index (BMI). The aim of this study was to compare the perioperative complications, weight loss, and comorbidity remission between laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) among patients with BMI ≥ 60 kg/m2.

Methods

Data from a statewide bariatric surgery registry were used to identify all patients with BMI ≥ 60 kg/m2 undergoing LRYGB or LSG between January 2006 and June 2019. Risk and reliability adjustment were used to compare outcomes between the two groups.

Results

A total of 6015 patients were identified and 2505 (41.6%) underwent LRYGB and 3510 (58.4%) underwent LSG. The overall mean age was 43.1 ± 11.2 years with a mean preoperative BMI of 66.7 ± 6.4 kg/m2. Females accounted for 69.3% and the majority were either white (68.5%) or black (21.2%). LRYGB was associated with a higher rate of adjusted 30-day postoperative serious complications (4.0% vs 2.2%; p < 0.01) including anastomotic leak, obstruction, and bleeding. Resource utilization was also higher with LRYGB (23.7% vs 14.8%; p < 0.01) and included more emergency department visits, readmissions, reoperations, and length of stay ≥ 4 days. The overall 1-year follow-up rate was 38.8%. The adjusted percent total weight loss at 1 year was significantly higher following LRYGB compared to LSG (36.6 ± 9.3 vs 31.3 ± 9.3%; p < 0.01). LRYGB was associated with a higher rate of treatment discontinuation for diabetes mellitus, hyperlipidemia, and obstructive sleep apnea.

Conclusions

In patients with BMI ≥ 60 kg/m2, LRYGB was associated with better weight loss and medication discontinuation 1 year following surgery at the expense of an increase in perioperative complications and resource utilization compared to LSG.

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Authors and Affiliations

  1. Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Hassan Nasser, Tommy Ivanics & Arthur M. Carlin

  2. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Oliver A. Varban, Jonathan F. Finks, Aaron Bonham & Amir A. Ghaferi

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  1. Hassan Nasser
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  2. Tommy Ivanics
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  3. Oliver A. Varban
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  7. Arthur M. Carlin
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Corresponding author

Correspondence to Hassan Nasser.

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Disclosures

Dr. Oliver A. Varban receives salary support from Blue Cross Blue Shield of Michigan for participation and leadership in quality improvement projects through the Michigan Bariatric Surgery Collaborative. Dr. Jonathan F. Finks receives salary support from Blue Cross Blue Shield of Michigan in association with his participation in the Michigan Bariatric Surgery Collaborative. Dr. Amir A. Ghaferi is supported through grants from the Agency for Healthcare Research and Quality (Grant #: 5K08HS02362 and P30HS024403) and a Patient Centered Outcomes Research Institute Award (CE-1304–6596). Dr. Amir A. Ghaferi receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative. Dr. Arthur M. Carlin receives an honorarium from Blue Cross Blue Shield of Michigan as Executive Committee Chair of the Michigan Bariatric Surgery Collaborative. Dr. Hassan Nasser, Dr. Tommy Ivanics, and Aaron Bonham have no conflicts of interest or financial ties to disclose.

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Nasser, H., Ivanics, T., Varban, O.A. et al. Comparison of early outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy among patients with body mass index ≥ 60 kg/m2. Surg Endosc 35, 3115–3121 (2021). https://doi.org/10.1007/s00464-020-07750-x

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