Increased staple line leak rates following re-sleeve: analysis comparing re-sleeve versus Roux-en-Y gastric bypass conversion and primary sleeve gastrectomy

Jul 22, 2024Surgical endoscopy

Higher leak rates after repeat sleeve gastrectomy compared to first sleeve surgery or gastric bypass conversion

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Abstract

1.3% of patients who underwent re-sleeve experienced staple line leaks, significantly higher than the 0.1% in primary sleeve gastrectomy.

Re-sleeve surgery is associated with longer operative times, averaging 90.16 minutes compared to 68.32 minutes for primary sleeve gastrectomy.
Patients undergoing re-sleeve had higher rates of readmissions (5.5% vs. 2.1%), reoperations (2.3% vs. 0.6%), and interventions (2.5% vs. 0.4%) compared to primary sleeve gastrectomy.
In comparisons of re-sleeve to conversion from sleeve gastrectomy to Roux-en-Y gastric bypass, re-sleeve also showed higher staple line leak rates (1.3% vs. 0.5%).
The study indicates a 2.6-fold increase in staple line leaks after re-sleeve compared to conversion to Roux-en-Y gastric bypass.
There is a 13-fold increase in staple line leaks after re-sleeve compared to primary sleeve gastrectomy.

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BACKGROUND: Sleeve gastrectomy is the most common bariatric procedure and its long-term complications include inadequate weight loss, weight regain, and de novo GERD, often requiring revisional surgery. Revisions, notably re-sleeve and conversion to Roux-en-Y gastric bypass (RYGB), are frequently performed, but safety data is limited. Herein, we used the MBSAQIP database to compare 30 day outcomes of primary sleeve gastrectomy (SG) with re-sleeve (RS) and SG to RYGB conversion.

METHODS: Patients who underwent primary SG, RS, and SG to RYGB conversion within the MBSAQIP data registry from January 1, 2020 to December 31, 2022 were included in this study. Using Propensity Score Matching analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30 day postoperative outcomes and bariatric-specific complications between primary SG and RS (analysis 1) and between RS and SG to RYGB conversion (analysis 2).

RESULTS: A total of 302,961 were included. The matched cohorts in analysis 1 (n = 1630) and analysis 2 (n = 1633) had similar pre-operative characteristics. Propensity-matched outcomes in analysis 1 showed that patients in the RS group had significantly higher staple line leak (1.3% vs. 0.1%, p < 0.001) when compared to primary SG. Similarly, longer operative times (90.16 ± 51.90 min vs. 68.32 ± 37.54 min, p < 0.001) and higher rates of readmissions (5.5% vs. 2.1%, p < 0.001), reoperations (2.3% vs. 0.6%, p < 0.001), interventions (2.5% vs. 0.4%, p < 0.001) were found in those who underwent RS. In analysis 2, RS showed higher leak rates (1.3% vs. 0.5%, p = 0.015) when compared to conversion from SG to RYGB.

CONCLUSION: The RS group has a higher risk of staple line leaks compared to primary SG and conversion from SG to RYGB. In our study, there was a 2.6-fold increase in staple line leak after re-sleeve compared to RYGB conversion and a 13-fold increase compared to primary SG.

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Increased staple line leak rates following re-sleeve: analysis comparing re-sleeve versus Roux-en-Y gastric bypass conversion and primary sleeve gastrectomy

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