When do leaks occur? An analysis of the metabolic and bariatric surgery accreditation and quality improvement program

Clapp, Benjamin; Corbett, John; Ahmad, Maria; Vivar, Andres; Sharma, Ishna; Hage, Karl; Ghanem, Omar M.

doi:10.1016/j.soard.2023.04.334

Cited by 8 publications

(2 citation statements)

References 19 publications

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“…These higher rates may be attributed to the longer operative time, higher complexity of the procedure, as well as the extensive surgical manipulation leading to altered gut anatomy and wound healing [ 17 ]. Anastomotic leaks can occur up to three weeks after surgery, emphasizing the need for vigilance post-bariatric surgery [ 19 ]. Unfortunately, the 30-day limitation of the MBSAQIP fails to fully capture the real-world implications of anastomotic leaks.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the 30-day limitation of the MBSAQIP fails to fully capture the real-world implications of anastomotic leaks. In fact, some studies showed that leaks are an independent predictor of increased long-term mortality, malnutrition, and overall serious complications [ 19 , 20 ]. This raises the issue of whether the higher incidence of leaks reflects an increase in long-term mortality associated with duodenal switch, a matter that was not covered in this study and requires further long-term evaluation.…”

Section: Discussionmentioning

confidence: 99%

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Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Hage,

Barajas-Gamboa,

Romero-Velez

et al. 2023

JCM

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Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days. Methods: Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality. Results: Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications. Conclusion: RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Hage,

Barajas-Gamboa,

Romero-Velez

et al. 2023

JCM

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Magnetic single‐anastomosis side‐to‐side duodeno‐ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1‐year outcomes

Gagner,

Almutlaq,

Gnanhoue

et al. 2024

World j. surg.

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IntroductionUncomplicated surgical approaches that minimize anastomotic complications while improving revisional metabolic/bariatric surgical (MBS) outcomes are needed.MethodsThis prospective single‐center study assessed the feasibility, safety, and efficacy of the novel linear magnetic anastomosis system (LMAS [3 cm]) in performing a side‐to‐side duodeno‐ileostomy (MagDI) bipartition to revise clinically suboptimal primary sleeve gastrectomy (SG). Patients with severe obesity with/without type 2 diabetes (T2D) with suboptimal weight loss, regain, and/or T2D recurrence post SG underwent revisional MagDI. A distal and proximal magnet were delivered endoscopically to the ileum and duodenum and aligned via laparoscopic assistance. Gradual magnet fusion formed a DI bipartition. Primary endpoints: technical feasibility, safety (Clavien‐Dindo [CD] severe adverse event classification) at 1 year. Secondary endpoints: MBS weight and T2D reduction.ResultsJuly 29, 2022–March 28, 2023, 24 patients (95.8% female, mean age 44.9 ± 1.5 years, and body mass index [BMI] 39.4 ± 1.3 kg/m2) underwent MagDI. Feasibility was attained via correct magnet placement (mean operative time 63.5 ± 3.3 min), patent anastomoses created, and magnet passage per anus in 100.0% of patients. There were 4 CD‐III mild or moderate severe AEs, 0.0% associated with the LMAS or MagDI: 0.0% anastomotic leakage, obstruction, bleeding, infection, reintervention, or death. Mean BMI reduction was 2.1 kg/m2 (p < 0.05); total weight loss 5.3%, excess weight loss 16.4%; and the patient with T2D improved.ConclusionThe single‐anastomosis MagDI procedure using the novel 3‐cm LMAS to revise clinically suboptimal SG was technically straightforward, incurred no major complications, mitigated weight regain, and renewed clinically meaningful weight loss.Clinicaltrials.gov IdentifierNCT05322122.

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Bariatric surgery: trends in utilization, complications, conversions and revisions

Hsu,

Ismail,

Hodges

et al. 2024

Surg Endosc

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Background Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This study aims to evaluate recent trends in the utilization of bariatric procedures, associated complications, and conversions using an administrative claims database in the United States. Methods We included adults who had bariatric procedures from 2000 to 2020 with continuous enrollment for at least 6 months in the MarketScan Commercial Claims and Encounters database. Index bariatric procedures and subsequent revisions or conversions were identified using CPT codes. Baseline comorbidities and postoperative complications were identified with ICD-9-CM and ICD-10 codes. Cumulative incidences of complications were estimated at 30-days, 6-months, and 1-year and compared with stabilized inverse probability of treatment weighted Kaplan–Meier analysis. Results We identified 349,411 bariatric procedures and 5521 conversions or revisions. The sampled SG volume appeared to begin declining in 2018 while Roux-en-Y gastric bypass (RYGB) remained steady. Compared to RYGB, SG was associated with lower 1-year incidence [aHR, (95% CIs)] for 30-days readmission [0.65, (0.64–0.68)], dehydration [0.75, (0.73–0.78)], nausea or vomiting [0.70, (0.69–0.72)], dysphagia [0.55, (0.53–0.57)], and gastrointestinal hemorrhage [0.43, (0.40–0.46)]. Compared to RYGB, SG was associated with higher 1-year incidence [aHR, (95% CIs)] of esophagogastroduodenoscopy [1.13, (1.11–1.15)], heartburn [1.38, (1.28–1.49)], gastritis [4.28, (4.14–4.44)], portal vein thrombosis [3.93, (2.82–5.48)], and hernias of all types [1.36, (1.34–1.39)]. There were more conversions from SG to RYGB than re-sleeving procedures. SG had a significantly lower 1-year incidence of other non-revisional surgical interventions when compared to RYGB. Conclusions The overall volume of bariatric procedures within the claims database appeared to be declining over the last 10 years. The decreasing proportion of SG and the increasing proportion of RYGB suggest the specific complications of SG may be driving this trend. Clearly, RYGB should remain an important tool in the bariatric surgeon’s armamentarium.

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When do leaks occur? An analysis of the metabolic and bariatric surgery accreditation and quality improvement program

Cited by 8 publications

References 19 publications

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Magnetic single‐anastomosis side‐to‐side duodeno‐ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1‐year outcomes

Bariatric surgery: trends in utilization, complications, conversions and revisions

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