Laparoscopic Roux-en-Y gastric bypass is as safe as laparoscopic sleeve gastrectomy. Results of a comparative cohort study

Abstract

BackgroundA meta-analysis and six randomized controlled trials show higher 30-day complication rates with laparoscopic Roux-en-Y gastric bypass (LRYGB) than with laparoscopic sleeve gastrectomy (LSG).AimTo identify any difference in 30-day outcomes of patients treated with LRYGB or LSG when a standardized technique and identical post-operative protocol was followed with all procedures being conducted either by or under the supervision of a single consultant surgeon who had significant experience in bariatric surgery prior to commencing independent practice.MethodsA prospectively collected database of all patients under primary LRYGB or LSG, between March 2010 and February 2017, was analyzed. Data on demographics, length-of-stay (LOS), conversion to open, 30-day complications and mortality were reviewed.ResultsOver a seven-year period, 485 patients (LRYGB-279 and LSG-206) were included. There were no significant demographic differences and no difference in the pre-operative risk scoring [American Society of Anesthesiologists (ASA) and obesity surgery mortality risk score (OSMRS)] between the groups. There was no significant difference between the groups in terms of LOS (p = 0.275), complications (p = 0.920), re-admissions (p = 0.593) or re-operations (p = 0.366) within 30-days. There were no conversions to open or in-patient mortality in either group.ConclusionsUnlike previous studies, we found no difference in early complication rates between LRYGB and LSG in a comparable cohort when performed by a surgeon with sufficient experience in bariatric surgery.

The Risk of Post-operative Complications in Super-Super Obesity Compared to Super Obesity in Accredited Bariatric Surgery Centers

“…Individually, the rates of specific complications compared favorably with NSQIP and the Michigan Bariatric Surgical Collaborative with similar rates of acute renal failure (0.1% vs. 0.1% and 0.2% respectively), urinary tract infection (0.5% vs. 0.7% and 0.3% respectively), pneumonia (0.2% vs. 0.5% and 0.9% respectively), unplanned intubation (0.2% vs. 0.3% and 0.4% respectively), vein thrombosis (0.1% vs. 0.3% and 0.4% respectively), and death (0.1% vs. 0.2% and 0.1% respectively). Overall, the higher complication rate in this study appears to be driven by the increased number of complications recorded in the 2016 [10]. And although a large meta-analysis of singlecenter studies did not find any difference in leak or mortality rates between LRYGB and LSG, most reported data shows an increased complication rate in patients undergoing LRYGB versus LSG [11][12][13].…”

A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis

“…However, there is a sharp trend towards the utilization of LSG over the last decade and a decline in the use of LRYGB [8,9]. Some studies suggest that LSG is easier and faster to perform and potentially safer compared with LRYGB [8,10], while some indicate that LRYGB is more potent than LSG [11][12][13].…”

Safety and efficacy of laparoscopic sleeve gastrectomy versus laparoscopic Roux‐en‐Y gastric bypass: A systematic review and meta‐analysis

“…The safety and efficacy of LSG versus LRYGB are controversial. Severe studies suggested that LSG is an easier surgery with lower complication rate and shorter learning curve than LRYGB; however, some studies demonstrated that LRYGB is as safe as LSG . The outcomes of meta‐analyses comparing LSG and LRYGB are discrepant.…”