By Marilynn Larkin
NEW YORK (Reuters Health) - 1/7/2019
Sleeve gastrectomy (SG) conferred a significantly lower risk of reintervention at five years compared to Roux-en-Y gastric bypass (RYGB) in a retrospective analysis of patients who underwent the procedures between 2005 and 2015.
"This paper focused only on adverse events after RYGB or sleeve gastrectomy and...the potential benefits of the two different operations in that time frame (should be taken into consideration) as well," Dr. Robert Li of Kaiser Permanente Northern California in Oakland told Reuters Health in a phone interview. "Nevertheless, this paper is important in that detailed follow-up on adverse outcomes is reported at five years; many other bariatric databases or registries report only 30-day or one-year outcomes."
"The RYGB cohort was in general heavier, and had more comorbidities - specifically, gastroesophageal reflux disease (GERD) and diabetes," he noted. "Subgroup analyses suggested higher BMI and diabetes and GERD were associated with a need for reintervention at five years, so patient selection may play a role in the higher risk for reintervention seen in the RYGB cohort."
Dr. Li and colleagues studied risks of nutritional, endoscopic, radiologic, and surgical reintervention as well as the overall risk of any reinterventions at one, three, and five years in 15,319 adults who underwent SG and 19,954 who underwent RYGB. Overall, about 20% were men; about 62% were ages 21-49; 33%, 50-64, and 4%, 65-79.
As reported online June 1 in the Annals of Surgery, the overall risk of any reintervention at five years was 21.3% for SG and 28.3% for RYGB. Adjusted hazard ratios for the associations of SG compared with RYGB with any reintervention at one, three, and five years were 0.66, 0.75, and 0.78, respectively.
Compared with a BMI of 40 to 49.9 kg/m2, low and high preoperative BMI (up to 39.9 and >50 kg/m2) were associated with a greater risk of any reintervention.
Further, when comparing subcategories, SG also had a lower risk of nutritional, endoscopic, radiologic, and surgical reinterventions compared to RYGB. The findings for risks of reinterventions were consistent across clinical subgroups.
"The long-term safety profile of (laparoscopic) SG compared with RYGB should be an essential part of the discussion in patient-centered decision making when choosing between bariatric procedure options," the authors conclude.
"Understanding the limitations of this study is essential for differentiating these results with those published previously," they note. First, patients were not randomized to the two surgical approaches, so the comparison "may have been biased by unmeasured patient selection factors and other confounding elements."
Second, most SG procedures were performed in the last three years of the study; therefore, the number of patients in this group followed for five years was limited.
Third, because SG was performed more commonly in the later part of the study, "outcomes may have been impacted by programmatic improvements in care over time as well as surgeons being more mature on the learning curve."
Further, there was no information on the diagnoses associated with reinterventions.
Dr. Mir Ali, a bariatric surgeon at MemorialCare Orange Coast Medical Center in Fountain Valley, California, commented in an email to Reuters Health, "This study only looked at re-intervention after sleeve versus gastric bypass. What was not looked at was weight loss, patient satisfaction, and weight regain for both procedures. These other factors may determine which is the correct procedure for the patient."
"Patient compliance is also important," he noted. "Both groups of patients do need to take life-long supplements, eat slow and have regular follow-up. Complications can occur in either group with poor compliance."
Ann Surg 2019.