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Perioperative risk should not be a main deciding factor in the choice of procedure

Both sleeve gastrectomy and Roux-en-Y gastric bypass can be performed with a similar and low perioperative risk therefore, the perioperative risk should not be a main deciding factor in the choice of procedure, according to the findings of a study conducted at the University of Gothenburg, Sweden.

Photo (Suzanne Hedberg, Credit Robert Lipic)

"For both surgical procedures, the risk of complications is very low, especially from an international perspective, and there is no statistically significant or clinically relevant difference between the groups," explained Suzanne Hedberg, first author of the study and a consultant at Sahlgrenska University Hospital. "Many people have had surgery, or are on waiting lists for surgery, and there are lots of discussions and opinions about the different methods. What the study shows is that patients and doctors can now choose their surgical method without considering short-term surgical risks."

Every year, around 5,000 bariatric procedures are performed in Sweden. The person undergoing surgery will normally have a BMI of at least 40, or 35 if they also have other serious medical conditions related to obesity. The most common procedures are gastric bypass and sleeve. The aim of the current study was to compare the short-term risks of the different procedures.

In this registry-based, multicentre randomised clinical trial (Bypass Equipoise Sleeve Trial, BEST), baseline and perioperative data for patients undergoing bariatric surgery from October 2015 to March 2022, were analysed. Patients were from university, regional, county, and private hospitals in Sweden (n=20) and Norway (n=3). In total, 1,735 adult patients (1,282; 73.9% female) eligible for bariatric surgery with body mass indexes of 35 to 50 were randomly assigned to either gastric bypass (n=857) or gastric sleeve (n=878). The main outcomes and measures were perioperative complications as all adverse events and serious adverse events (Clavien-Dindo grade >IIIb). Ninety-day mortality was also assessed.

Unsurprisingly, the mean (SD) operating time was shorter in those undergoing SG vs RYGB (47 [18] vs 68 [25] minutes; p<0.001). The median (IQR) postoperative hospital stay was 1 (1-1) day in both groups. The 30-day readmission rate was 3.1% after SG and 4.0% after RYGB (p=0.33). There was no 90-day mortality. The 30-day incidence of any adverse event was 40 (4.6%) and 54 (6.3%) in the SG and RYGB groups, respectively (p=0.11). Corresponding figures for serious adverse events were 15 (1.7%) for the SG group and 23 (2.7%) for the RYGB group (p=0.19).

The only significant difference of serious adverse events between the groups was for small bowel obstruction, occurring in 0 of 872 patients (0%) in the SG group and 6 of 850 (0.7%) in the RYGB group (p=0.01). There were 41 complications registered at subsequent operation in 37 patients. There were no adverse events with a Clavien-Dindo grade higher than IIIb. There was no interaction in the risk of complications at 30 days between SG and RYGB in the predefined subgroups (sex, age, BMI, diabetes and smoking).

"For the ongoing studies, we are off to a good start with equivalent groups, laying a good foundation for further comparisons of more long-term results," added Hedberg.

The findings were reported in the paper, ‘Comparison of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass”, published in JAMA Network Open. To access this paper, please click here

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