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1 in 10 have serious problems after bariatric surgery

Roux-en-Y bypass linked to greater five-year risks than gastric sleeve, but also better for weight loss

Louise Prime

Thursday, 16 January 2020

Serious problems are relatively common following bariatric surgery, affecting about one in 10 patients, and are more common in people who had gastric bypass than in those who had a gastric sleeve, researchers have reported* in JAMA Surgery. They called for better-informed discussion of the risks and benefits of the different types of surgery to help patients decide which is best for them, given that bypass has previously been shown to result in greater weight loss.

The team, led from the University of Pittsburgh, Pennsylvania, investigated outcomes among 33,560 women and men (mean age 45.0 years and mean body mass index (BMI) 49.1) who had had bariatric surgery in the US between January 2005 and September 2015: 18,056 (54%) Roux-en-Y gastric bypass (RYGB) and 15,504 (46%) sleeve gastrectomy (SG).

They compared the risks of intervention, operation, endoscopy, hospitalisation, and mortality up to five years after RYGB and SG and found that overall, operation or intervention was less likely for SG than for RYGB (hazard ratio, HR 0.72). The estimated cumulative probability of operation or intervention after SG was 2.89% at one year, 6.35% at three years, and 8.94% at five years – whereas after RYGB it was 4.02% at one year, 8.76% at three years, and 12.27% at five years.

Hospitalisation was less likely after SG than after RYGB (HR 0.82); the five-year adjusted cumulative incidence rates were 32.79% for SG and 38.33% for RYGB. Endoscopy was also less likely for SG than for RYGB (HR 0.47); the adjusted cumulative incidence rates at five years were 7.80% for SG and 15.83% for RYGB.

Furthermore, revision appeared more common after SG than after RYGB, although not statistically significantly so. There were no differences in all-cause mortality between the two procedures.

The researchers noted: “The benefit of SG over RYGB for the primary outcome was higher among patients with lower baseline BMI (eg <50) and in those with lower comorbidity burden. These findings suggest that people with higher BMI or more comorbid disease do better with SG than with RYGB, but people with lower BMI or less comorbid diseases do even better with SG than RYGB.”

However, they pointed out that the potential benefits are greater with RYGB compared with SG, as well as the risks – earlier research using the same dataset showed that it resulted in significantly more weight loss.

The study authors acknowledged a few limitations of their study, such as that it was non-randomised and risked residual unmeasured confounding, but added that as well as having better-than-typical ethnic and racial diversity, “it was one of the largest bariatric surgery cohorts ever studied … including a large number of SG cases, which is currently the most common bariatric operation.”

They concluded: “This study showed that problems, including interventions, operations, and hospitalisations, were relatively common after bariatric surgical procedures and were more often associated with RYGB than with SG.” They said their results on weight loss and risk, together with further study of large data sets linked to insurance claims and mortality data, would help inform procedure-specific decision making for prospective patients and physicians.

They commented: “What we advocate is high-quality shared decision making between providers and patients. It starts with a conversation about what their preferences and values are. Some people value low risk, some value high weight loss. It’s important to have information on both sides of the risk-benefit equation.”

* Courcoulas A, Coley RY, Clark JM, et al. Interventions and operations 5 years after bariatric surgery in a cohort from the US national patient-centered clinical research network bariatric study. JAMA Surg. Published online January 15, 2020. doi:10.1001/jamasurg.2019.5470

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