Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database

Stenberg, Erik; Szabó, Éva; Ottosson, Johan; Näslund, Ingmar

doi:10.1002/bjs.10448

Cited by 16 publications

(12 citation statements)

References 30 publications

(44 reference statements)

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“…In contrast to the higher hypertension remission rate seen after gastric bypass compared with sleeve gastrectomy in the SLEEVEPASS study [34] (51% for gastric bypass and 29% for sleeve gastrectomy), no difference was seen in the chance of achieving hypertension remission between gastric bypass and sleeve gastrectomy in the present study. Study groups in randomised clinical trials, however, are often highly selected, providing results that are more impressive than those seen in routine clinical practice [35,36]. Moreover, the present study was not designed to compare the 2 surgical methods, which is why this result should be viewed with caution.…”

Section: Plos Medicinementioning

confidence: 95%

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

et al. 2020

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Background Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] � 35 kg/m 2) and hypertension. Methods and findings We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched nonoperated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/ m 2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060)

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Section: Plos Medicinementioning

confidence: 95%

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

et al. 2020

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“…Despite this, the risk for slight underestimation of the number of reoperations for small bowel obstruction remains. Based on previous reports, it is likely that this would affect the control group to a greater extent and would therefore underestimate the beneficial effect of treatment of mesenteric defects closure to some extent [8]. Many patients in the clip group were censored before postoperative year five due to limited follow-up time, limiting the evaluation of long-term efficacy for this group.…”

Section: Discussionmentioning

confidence: 99%

“…All charts for patients with a diagnosis of K45.8 (other specified abdominal hernia without obstruction) or with any uncertainty in the registration in SOReg or NPR were reviewed. Small bowel obstruction was then defined as acute presentation of abdominal pain with objective finding of bowel obstruction at surgery [8,10].…”

Section: Methodsmentioning

confidence: 99%

“…During the same period of time, small bowel obstruction due to internal hernia following surgery has increased dramatically [5] with potentially devastating consequences for the patient [6,7]. Closure of the mesenteric defects reduces the risk for small bowel obstruction [8] and is now an accepted part of any laparoscopic gastric bypass procedure in many parts of the world. Several methods are available for mesenteric defects closure.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

et al. 2019

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Background Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery. Methods Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts. Results In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001). Conclusion Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.

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“…The surgical technique for laparoscopic gastric bypass surgery, however, is well standardized in Sweden today, and when the mesenteric defects are closed with sutures, most surgeons close the mesenteric defects with the same technique [13]. Furthermore, the effects of mesenteric defect closure in general surgical practice is also well documented [29]. Although routine closure of the mesenteric defects is well accepted throughout Sweden today, many centers have shifted their preference to metal clips instead of running, non-absorbable sutures over more recent years which explains the lower numbers during the second period.…”

Section: Discussionmentioning

confidence: 99%

Impact of mesenteric defect closure technique on complications after gastric bypass

Stenberg

Näslund

Szabó

et al. 2018

Langenbecks Arch Surg

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BackgroundClosure of mesenteric defects during laparoscopic gastric bypass surgery markedly reduces the risk for small bowel obstruction due to internal hernia. However, this procedure is associated with an increased risk for early small bowel obstruction and pulmonary complication. The purpose of the present study was to evaluate whether the learning curve and subsequent adaptions made to the technique have had an effect on the risk for complications.MethodsThe results of patients operated with a primary laparoscopic gastric bypass procedure, including closure of the mesenteric defects with sutures, during a period soon after introduction (January 1, 2010–December 31, 2011) were compared to those of patients operated recently (January 1, 2014–June 30, 2017). Data were retrieved from the Scandinavian Obesity Surgery Registry (SOReg). The main outcome was reoperation for small bowel obstruction within 30 days after surgery.ResultsA total of 5444 patients were included in the first group (period 1), and 1908 in the second group (period 2). Thirty-day follow-up rates were 97.1 and 97.5% respectively. The risk for early (within 30 days) small bowel obstruction was lower in period 2 than in period 1 (13/1860, 0.7% vs. 67/5285, 1.3%, OR 0.55 (0.30–0.99), p = 0.045). The risk for pulmonary complication was also reduced (5/1860, 0.3%, vs. 41/5285, 0.8%, OR 0.34 (0.14–0.87), p = 0.019).ConclusionClosure of mesenteric defects during laparoscopic gastric bypass surgery can be performed safely and should be viewed as a routine part of that operation.

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Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database

Abstract: The efficacy of mesenteric defect closure was similar in the RCT and national registry, providing evidence for the external validity of the RCT.

Cited by 16 publications

References 30 publications

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery—a Register-Based Cohort Study

Impact of mesenteric defect closure technique on complications after gastric bypass

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