Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis

Abstract

In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32–1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46–0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53–0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43–0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55–0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.

Global 30-day outcomes after bariatric surgery during the COVID-19 pandemic (GENEVA): an international cohort study

“…The overall 30-day mortality of 0·05% (1/2001) seen in this study is consistent with the pre-pandemic figures reported in BMS studies (0·04–0·1%) 4 , 5 , 6 and the 30-day mortality of about 0·1% (1/1142) with SG in this study is similar to the figure of 0·1% reported in a study of 29 588 patients. 7 In a recent systematic review, 8 30-day complications occurred in 10·1% (319/3155) of patients who had Roux-en-Y gastric bypass (RYGB) and in 5·4% (155/2876) of patients who had SG, which is similar to the rates seen in our study (8·4% and 5·7%, respectively; table ). Similarly, Stenberg and colleagues 6 reported 7·8% (196/2503) of patients with 30-day complications following RYGB.…”

“… 6 The rates of 30-day severe complications (CD grade III, IV, or V) with RYGB and SG in this study (3·2% and 2·1%, respectively; table ) are also similar to those reported in previous studies. 4 , 6 , 7 …”

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

“…These figures have remained broadly unchanged at 6.76% and 0.14% even though we now have 7084 elective primary BS patients as opposed to 2001 in our initial report [19]. These figures appear similar to large pre-pandemic BS datasets [26][27][28]. It would be particularly interesting to know what percentage of patients undergoing BS during the pandemic develops symptomatic COVID-19 postoperatively and the outcomes of those who were inadvertently operated on whilst positive for SARS-CoV-2 at the time of the surgery.…”

Complications associated with laparoscopic sleeve gastrectomy – a review

“…The register kept by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has noted 394,431 bariatric procedures performed in 51 countries since 2014. The most frequently performed surgery has been laparoscopic sleeve gastrectomy, which constitutes 46.0% of all interventions [ 7 ]. LSG is currently considered to be the most effective treatment solution for morbid obesity, which leads not only to achieve significant and permanent weight loss, but also to partial or total remission of obesity-related comorbidities [ 8 , 9 ].…”