Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch

Aug 2, 2011Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Early results of three types of weight-loss surgeries: sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch

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Abstract

Among 507 bariatric procedures, no fatalities occurred after sleeve gastrectomy (SG), but it did not show a lower rate of complications compared to Roux-en-Y gastric bypass (RYGB).

Biliopancreatic diversion with duodenal switch (BPD-DS) had a significantly higher complication rate compared to RYGB.
Patients undergoing SG were significantly older and had more co-morbidities than those receiving RYGB or BPD-DS.
One death was reported after RYGB, while no fatalities occurred following SG or BPD-DS.
Bleeding complications were more common in both SG and BPD-DS compared to RYGB.
The differences in preoperative body mass index and co-morbidities among the groups complicate the assessment of postoperative morbidity.

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BACKGROUND: Since the introduction of the isolated sleeve gastrectomy in 1997, this procedure has gained immense popularity in the hopes of reducing the operative risks with a less complex operation. We reviewed our recent 2-year experience with bariatric surgery to compare the early outcomes of the 3 complex procedures routinely performed by our private practice at a single institution: sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD-DS).

METHODS: The 30-day morbidity and 90-day mortality rates were retrospectively reviewed among a total of 507 primary bariatric procedures. The early postoperative outcomes of 360 RYGB, 88 SG, and 59 BPD-DS procedures performed during this period were compared.

RESULTS: The patients weighed more in the BPD-DS and SG groups. The SG patients were significantly older than the RYGB and BPD-DS patients. Co-morbidities were significantly more frequent in the SG and BPD-DS patients. One patient died after RYGB but none did so after BPD-DS or SG. The global complication rate was significantly increased after BPD-DS (P = .0017) compared with RYGB; however, no difference was found between RYGB and SG, although bleeding was likely to appear more frequent, not only after BPD-DS, but also after SG compared with RYGB.

CONCLUSION: Although no fatal outcomes occurred after SG, this procedure did not demonstrate a reduced risk of postoperative complications compared with RYGB with a significantly greater rate of bleeding. RYGB appears to be a relatively safe bariatric procedure, although the groups were not comparable in terms of the preoperative body mass index or co-morbidities, the exact role of which on postoperative morbidity remains controversial. Although the increased risk of RYGB to BPD-DS was confirmed, SG failed to live up to its "more benign" reputation.

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Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch

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