Perioperative Risks of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass Among Patients With Chronic Kidney Disease

Montgomery, John R.; Waits, Seth A.; Dimick, Justin B.; Telem, Dana A.

doi:10.1097/sla.0000000000003627

Cited by 17 publications

(6 citation statements)

References 44 publications

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“…Our results are comparable with those of other international studies. In the study by Montgomery et al [13], the same results were shown regarding the overall rate of intraoperative and postoperative complications. This is also true for the study by Topart et al [14] and the randomized trial by Helmiö et al [15].…”

Section: Discussionsupporting

confidence: 56%

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Thaher¹,

Driouch²,

Hukauf³

2021

World J. Adv. Res. Rev.

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Background: Despite the extensive literature on the outcome and impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on comorbidities and weight loss, clear evidence is still lacking. Our study aims to compare the short- and long-term efficacy and safety of the two procedures in patients with obesity. Methods: The primary endpoint of this retrospective registry study is to examine the adverse events after surgery, weight loss, and remission rate of comorbidities 12 months after surgery. Any result with a p-value of ≤ 5% corresponds to a significant outcome. Results: 27,882 patients had completed a one-year follow-up. 14,399 patients after SG and 13,483 after RYGB. The overall rate of intraoperative and postoperative complications was not significantly different between the two groups (overall p>5%). The %EWL was 62.4% in the SG group vs. 69.2% in the RYGB group; p<0.001. BMI reduction and mean weight loss were significantly different between the two groups in favor of SG. The RYGB group achieved significantly better remission of diabetes mellitus (T2DM; p<0.001), hypertension (28.8% vs. 23.5%; p < 0.001) and reflux 22.3% vs. 7.8%; p<0.001). Sleep apnea remission was similar between the two groups (10.2%; p<0.001). Conclusion: SG and RYGB are effective methods in the treatment of obesity. RYGB achieved better results in terms of remission of comorbidities and %EWL. However, further studies are needed to investigate the sustainability of weight loss and remission of comorbidities after both procedures.

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Section: Discussionsupporting

confidence: 56%

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Thaher¹,

Driouch²,

Hukauf³

2021

World J. Adv. Res. Rev.

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“…This practice was previously driven by short-term concerns that these patients are of prohibitive surgical risk . However, work suggests that surgical complication rates are low and comparable with patients without end-stage kidney disease . Long-term concerns remain, arising from disagreement between the potential benefits of bariatric surgery and the obesity paradox, an observation that patients undergoing dialysis with higher body mass index actually have lower all-cause mortality .…”

Section: Introductionmentioning

confidence: 99%

Bariatric Surgery and Long-term Survival in Patients With Obesity and End-stage Kidney Disease

et al. 2020

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IMPORTANCEObesity rates in patients with end-stage kidney disease are rising, contribute to excess morbidity, and limit access to kidney transplant. Despite this, there continues to be controversy around the use of bariatric surgery in this patient population.OBJECTIVE To determine whether bariatric surgery is associated with improvement in long-term survival among patients with obesity and end-stage kidney disease.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study and secondary analysis of previously collected data from the United States Renal Data System registry (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We used Cox proportional hazards analysis to evaluate differences in outcomes for patients receiving bariatric surgery (n = 1597) compared with a matched cohort of nonsurgical patients (n = 4750) receiving usual care. Data were analyzed between September 3, 2019, and November 13, 2019. EXPOSURE Receipt of bariatric surgery.MAIN OUTCOMES AND MEASURES All-cause mortality at 5 years. Secondary outcomes included disease-specific mortality and incidence of kidney transplant.RESULTS Surgical and nonsurgical control patients had similar age, demographics, and comorbid disease burden. The mean (SD) age was 49.8 (11.2) years for surgical patients vs 51.7 (11.1) years for nonsurgical patients. Six hundred fifteen surgical patients (38.5%) were black vs 1833 nonsurgical patients (38.6%). Surgery was associated with lower all-cause mortality at 5 years compared with usual care (cumulative incidence, 25.6% vs 39.8%; hazard ratio, 0.69, 95% CI, 0.60-0.78). This was driven by lower mortality from cardiovascular causes at 5 years for patients undergoing bariatric surgery compared with nonsurgical control patients (cumulative incidence, 8.4% vs 17.2%; hazard ratio, 0.51; 95% CI, 0.41-0.65). Bariatric surgery was also associated with an increase in kidney transplant at 5 years (cumulative incidence, 33.0% vs 20.4%; hazard ratio, 1.82; 95% CI, 1.58-2.09). However, at 1 year, bariatric surgery was associated with higher all-cause mortality compared with usual care (cumulative incidence, 8.6% vs 7.7%; hazard ratio, 1.45; 95% CI, 1.13-1.85).CONCLUSIONS AND RELEVANCE Among patients with obesity and end-stage kidney disease, bariatric surgery was associated with lower all-cause mortality compared with usual care. Bariatric surgery was also associated with an increase in kidney transplant. Bariatric surgery may warrant further consideration in the treatment of patients with obesity and end-stage kidney disease.

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“…Previous studies of LSG have reported success rates of 56% at a mean of 92 days to the same limit [14], and 100% success in a smaller cohort within three months, from a lower mean initial BMI (38.8 kg/m 2 ) [6]. The major complication rate (2.5%) in this cohort is lower than 7.06%, previously published for haemodialysis patients [17], and the overall complication rate of 11.3% is slightly lower than the combined surgical and medical complication rate of 6.2 + 8.3% for CKD patients from the MBSAQIP database [18]. This demonstrates the effectiveness, efficiency and relatively safety of LSG in helping patients become eligible for the kidney transplant waiting list.…”

Section: Discussionmentioning

confidence: 91%

Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation

et al. 2021

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Morbid obesity in kidney transplant (KT) candidates is associated with increased complications and graft failure. Multiple series have demonstrated rapid and significant weight loss after laparoscopic sleeve gastrectomy (LSG) in this population. Long-term and post-transplant weight evolutions are still largely unknown. A retrospective review was performed in eighty patients with end-stage kidney disease (ESKD) who underwent LSG in preparation for KT. From a median initial BMI of 43.7 kg/m 2 , the median change at 1-year was À10.0 kg/m 2 . Successful surgical weight loss (achieving a BMI < 35 kg/m 2 or an excess body weight loss >50%) was attained in 76.3% and was associated with male gender, predialysis status, lower obesity class and lack of coronary artery disease. Thirty-one patients subsequently received a KT with a median delay of 16.7 months. Weight regain (increase in BMI of 5 kg/m 2 postnadir) and recurrent obesity (weight regain + BMI > 35) remain a concern, occurring post-KT in 35.7% and 17.9%, respectively. Early LSG should be considered for morbidly obese patients with ESKD for improved weight loss outcomes. Early KT after LSG does not appear to affect short-term surgical weight loss. Candidates with a BMI of up to 45 kg/m 2 can have a reasonable expectation to achieve the limit within 1 year.

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Perioperative Risks of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass Among Patients With Chronic Kidney Disease

Cited by 17 publications

References 44 publications

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Bariatric Surgery and Long-term Survival in Patients With Obesity and End-stage Kidney Disease

Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation

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