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.
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.
Authors: Jeffrey I Mechanick; Adrienne Youdim; Daniel B Jones; W Timothy Garvey; Daniel L Hurley; M Molly McMahon; Leslie J Heinberg; Robert Kushner; Ted D Adams; Scott Shikora; John B Dixon; Stacy Brethauer Journal: Obesity (Silver Spring) Date: 2013-03 Impact factor: 5.002
Authors: Jeffrey I Mechanick; Adrienne Youdim; Daniel B Jones; W Timothy Garvey; Daniel L Hurley; M Molly McMahon; Leslie J Heinberg; Robert Kushner; Ted D Adams; Scott Shikora; John B Dixon; Stacy Brethauer Journal: Endocr Pract Date: 2013 Mar-Apr Impact factor: 3.443