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Gastric bypass vs sleeve gastrectomy

RYGB offers better weight loss but higher readmission rates vs LSG

Combined DATO and SOReg offers insights into current clinical practice across three countries

One-year outcomes from over 47,000 Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy procedures has reported that RYGB resulted in a higher rate of patients with total weight loss (TWL) >20% (95.8% vs 84.6%, p<0.001). However, there were no significant differences between the two procedures in the rate of severe complications (2.6% vs 2.4%, p=0.382) and 30-day mortality (0.04% vs 0.03%, p=0.821), although readmission rates were higher post-RYGB (4.3% vs 3.4%, p<0.001).

The study, ‘Gastric Bypass Versus Sleeve Gastrectomy’, published in the Annals of Surgery, sought to compare the use and short-term outcome of RYGB and sleeve gastrectomy in Sweden, Norway and the Netherlands, using data from Scandinavian Obesity Surgery Registry (SOReg) and the Dutch Audit for Treatment of Obesity (DATO). Specifically, the researchers examined patient eligibility for surgery, severe complications, mortality, readmissions, rate of follow-up and weight loss at one-year. All patients who had a primary RYGB or primary SG from January 2015 till December 2017 were included. In total, 47,101 procedures were included in the analysis; 33,029 (70.1%) RYGB and 14,072 (29.9%) sleeve gastrectomy procedures.

Outcomes

The most common procedure was RYGB (Sweden, 64.0%; the Netherlands, 77.0%), while SG was the most common procedure in Norway (57.0%, p<0.001). The results revealed that patients who has RYGB had more preoperative comorbidities compared to SG patients (73.5% vs 64.3%, p<0.001), and patients operated in the Netherlands had more comorbidities than both Sweden and Norway (p<0.001). Gastroesophageal reflux disease (GERD) was about twice as common in RYGB patients from Norway and Sweden, although there was no difference between the two procedures for patients from the Netherlands. In total, 42,030 patients (89.2%) met the eligibility criteria for bariatric surgery (91.9% for the RYGB and 83.0% for SG patients, respectively, p<0.001).

“Interestingly, we found that more RYGB patients were operated according to international guidelines for bariatric surgery than sleeve gastrectomy patients,” the authors commented. “This could be due the fact that there are some Swedish private clinics performing sleeve gastrectomy on patients with a BMI of 30 to 35 kg/m2 or 35 to 40 kg/m2 without any obesity-related comorbidity.”

In total, 846 patients (2.6%) had severe complications (CD-Grade IIIb) after RYGB and 341 (2.4%) patients after SG (p=0.382). Subsequent reinterventions (due to severe complications) were performed in 667 patients (2.0%) after RYGB and 290 (2.1%) patients after SG (p=0.771).

Thirty-day mortality was 0.04% (n=13) after RYGB and 0.03% (n=4) after SG (p=0.821). Bleeding (1.6%), leakage (0.7%) and wound infection (0.5%) were the three most common combined complications after RYGB and SG, although there was no statistical difference between the two procedures.

Patients who had RYGB had a shorter hospital stay (1.6 days vs 1.7 days, respectively, p<0.001). The length of hospital stay after RYGB and SG was comparable in the Netherlands, although in Norway and Sweden, hospital stay was shorter after RYGB than SG in the same country (p<0.001). The readmission rate was higher for patients who underwent RYGB than SG (4.3%; n=1,411 vs 3.4%; n=485, p<0.001), with the lowest readmission rates in the Netherlands, with Swedish hospitals having significantly higher readmission rates after RYGB (7.1%) than the overall average (p<0.001).

Total Weight Loss of more than 20% in the first year after surgery was reached more often after RYGB than SG (95.8% and 84.6%, respectively, p<0.001). There was a significant difference in 20% TWL after SG in Sweden (75.2%), Norway (93.4%) and the Netherlands (90.8%) (p<0.001), while the difference was smaller after RYGB (Sweden: 94.9%; Norway: 95.0%; Netherlands: 96.3%; p<0.001).

Conclusions

The authors noted that national databases and registries collect detailed data on patient characteristics, treatment and individual hospitals, and this data can made available for monitoring of quality indicators, facilitating comparisons relative to a national and an international benchmark analysis.

“The standardisation of registries and consensus of definitions of measures included facilitate comparisons between countries that may impact quality of the treatment given on an international level,” they concluded.

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