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.
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References
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.
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.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.
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.
Santry H, Gillen D, Lauderdale D. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.
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.
NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–61.
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.
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.
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
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.
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.
Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity. Exp Rev Med Devices. 2006;3:105–12.
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.
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.
McCarty T, Arnold D, Lamont J, et al. Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg. 2005;242:494–501.
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.
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.
Morais A, Faintuch J, Leal A, et al. Inflammation and biochemical features of bariatric candidates: does gender matter? Obes Surg. 2011;21:71–7.
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.
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.
LABS Consortium Writing Group. Perioperative safety in the Longitudinal Assessment of Bariatric Surgery. New Engl J Med. 2009;361:445–54.
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.
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.
Marshall J, Srivastava A, Gupta SK, et al. Roux-en-Y gastric bypass leak complications. Arch Surg. 2003;138:520–3.
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.
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.
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.
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.
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.
Deitel M, Gagner M, Erickson A, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.
Herron D, Roohipour R. Complications of Roux-en-Y gastric bypass and sleeve gastrectomy. Abdom Imaging. 2012;37:712–8.
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.
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.
Yu J, Turner M, Cho S, et al. Normal anatomy and complications after gastric bypass surgery: helical CT findings. Radiology. 2004;231:753–60.
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.
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.
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.
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.
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.
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.
Kothari S. Bariatric surgery and postoperative imaging. Surg Clin N Am. 2011;91:155–72.
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.
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.
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.
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.
Chiu C, Lee W, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16:913–8.
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.
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.
Birkmeyer N, Dimick J, Share D, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304:435–42.
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.
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The results of this study have been submitted for IFSO 2013 Congress in Turkey as an oral presentation. However, the result of this submission (acceptance for presentation or rejection) is not yet announced.
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Weiner, R.A., El-Sayes, I.A., Theodoridou, S. et al. Early Post-operative Complications: Incidence, Management, and Impact on Length of Hospital Stay. A Retrospective Comparison Between Laparoscopic Gastric Bypass and Sleeve Gastrectomy. OBES SURG 23, 2004–2012 (2013). https://doi.org/10.1007/s11695-013-1022-z
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DOI: https://doi.org/10.1007/s11695-013-1022-z