Gastric bypass is more likely to require additional treatment than gastric sleeve

A new study that analyzes the results of thousands of patients who underwent bariatric surgery reports that repeated hospitalization is much more likely with those who underwent gastric bypass surgery than with gastric sleeve surgery.

The article, which is published in the magazine. JAMA surgeryIt is important in the number of covered bariatric surgery patients and is the first to analyze the follow-up of a large number of bariatric surgery patients due to health problems years after the operation.

Vertical sleeve gastrectomy. Stomach Reduction Surgery Image credit: logika600 / Shutterstock

Bariatric surgery is a more effective way to treat obesity and induce a remission of type 2 diabetes mellitus compared to other nonsurgical measures in very obese people.

Comment researcher Anita Courcoulas, a specialist in minimally invasive bariatric surgery, “” In bariatric surgery, there has been an explosion of data, but most focus on positive results. This study is important because it includes adverse events that could worry people. “

For example, short-term risks for various procedures follow a gradient, and generally more complex procedures have a higher risk of death or adverse events. However, long-term risks include the rate of repeated surgery, which is much higher with low complexity procedures such as the adjustable gastric band (AGB). This has led to, for example, a fall in the number of AGBs) carried out worldwide.

The study

The researchers analyzed electronic medical records taken from some 33,500 patients who had undergone bariatric surgery in 10 medical centers during the period 2000 to 2015. These records were part of the PCORnet bariatric study (National Network of Patient-Centered Clinical Research).

The participation of multiple sites was an important part of the design of relevance in the study, so that the findings would be applicable to patients from different parts of the USA. UU. The link of electronic health records with health insurance claims and death records is an important step to ensure an accurate description of adverse events, which is often omitted if only bariatric surgeon reports are considered.

Of the patients, approximately half underwent the Roux-en-Y gastric bypass procedure and the rest under a sleeve gastrectomy.

In sleeve gastrectomy, a part of the stomach is removed to reduce capacity and patients feel full earlier during meals. This helps patients eat less and lose weight. In Roux-en-Y, the stomach is replaced by a bag created from the intestine, into which food enters once it is ingested. Therefore, the real stomach is avoided to encourage the consumption of small meals.

The scientists examined the data to see what happened five years after the first surgery.

The results

The researchers found that after a gastric bypass, a significantly larger number had had a second operation or another intervention in an abdominal organ, approximately 12% compared to 9% after a gastric sleeve operation. Both hospital admission rates and the appearance of endoscopy increased after gastric bypass, although the mortality rates remain the same in both groups.

Sleeve gastrectomy may have greater benefits over gastric bypass in patients who are less overweight and have fewer coexisting diseases.

The reasons for the higher surgical intervention rate after gastric bypass could be its greater complexity, according to Courcoulas, who does not forget that some of these interventions are intended to improve health, such as repairing a hernia. The researchers also point out that gastric bypass, although it seems to have slightly greater risks, may also have greater advantages. In fact, an earlier study examining the same data set shows that weight loss occurred to a significantly greater degree after gastric bypass than sleeve gastrectomy.

Transcendence

The researchers hope that these findings will one day help choose the type of bariatric surgery, either by patients or by the health care provider. When both participate in clinical decision-making, according to Courcoulas, “it begins with a conversation about what their preferences and values ​​are. Some people value low risk, others value high weight loss. It is important to have information on both sides of the risk-benefit equation. ” The current study will hopefully provide some missing details on both sides so that more people can make informed health decisions.

Journal reference:

Courcoulas A, Coley RY, Clark JM, et al. Interventions and operations 5 years after bariatric surgery in a cohort of the bariatric study of the national patient-centered clinical research network. UU. JAMA Surg. Published online January 15, 2020. doi: 10.1001 / jamasurg.2019.5470, https://jamanetwork.com/journals/jamasurgery/fullarticle/2758646

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