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Procedure comparision study

LSG has the lowest rates of procedure-related morbidity

LSG has lower complcation rates than bypass and banding
Raul Rosenthal

According to the outcomes of a new study presented at the ASMBS’ 29th Annual Meeting in San Diego, CA, when compared with other bariatric procedures laparoscopic sleeve gastrectomy (LSG) appears to have the lowest procedure related morbidity.

“The aim of the study was to identify which of the bariatric procedures performed today is the safest in terms of procedure related morbidity,” said Dr Raul J Rosenthal from the Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida. “So we carried out a single institution retrospective review of our centre’s six year experience since LSG was introduced comparing the procedure with Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).”

Rosenthal and colleagues retrospectively analysed a prospectively collected database in morbidly obese patients that underwent bariatric surgery between 2005 and 2011. They identified and compared complications, hospital stay, readmissions and re-operations in patients that underwent all three procedures.

A total of 2,433 bariatric procedures were performed during this period of time. There were no significant differences between the groups in terms of age, gender or BMI. Rosenthal explained that in his institution, banding is only applied to patients with a BMI 35-50, whereas LSG is applied to all patients including the high risk and RYGB is applied to all patients with a BMI of >35.

Outcomes

Of those procedures 1,492 were RYGB, 602 LSG and 339 LAGB. The number of readmissions was minimal in all three groups with RYGB 1.7 times, LSG 1.3 times and 1.5 times for LAGB. The percentage of procedures requiring reoperations due to complications or failures was 7.7% in the RYGB group, 1.5% in the LSG and 15.3% for the LAGB.

“LSG appears to have the lowest rate of re-operations when compared to banding and bypass, and surprisingly banding had the highest rate of re-intervention,” said Rosenthal. “The primary reason for removing bands was slippage, followed by failure and reflux.”

The outcomes also revealed that average postoperative length of stay was longer following RYGB (3.75 days) compared with LSG (3.4 days) and banding (1.47 days). The leakage rate was 0.4% for the RYGB and 0.3% for the LSG (leakage rates are not applicable for LAGB).

“One of the weaknesses of this study, as with all retrospective studies, is that patients were not randomised,” he explained. “Therefore, it could be that there is a patient population in one group or another that could trigger a difference in the outcomes.”

“However, I believe that this study adds to the body of evidence, which includes randomised studies and meta-analyses, that LSG is an outstanding treatment option for morbid obesity,” concluded Rosenthal. “I think the message from this relatively small study is that at this point LSG is the safest procedure when treating morbidly obese patients.”

The co-authors of the study were Drs Abraham Fridman, Karan Bath, Andre Teixeira and Samuel Szomstein.

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