Laparoscopic bariatric surgery has proven a safe and effective form of weight reduction in obese and morbidly obese patients. We present a query of national bariatric surgery data to investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) as compared to laparoscopic Roux-en-Y gastric bypass (LRYGB).
Patients were identified from the 2016 American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP). Laparoscopic sleeve gastrectomy was identified by Current Procedure Terminology (CPT) code 43775 and laparoscopic Roux-en-Y gastric bypass codes 43644 and 43645.
474,194 patients (136,133 LRYGB, 338,061 LSG) were identified. Significantly elevated rates of preoperative comorbidity were appreciated among LRYGB for reflux disease, hypertension, diabetes, limited patient mobility, myocardial infarction, deep vein thrombosis, and venous stasis (p<.05). Greater incidence of intraoperative stapling and length of procedure were also noted for LRYGB. Fewer postoperative complications were observed among the LSG cohort as well as lower unplanned ICU admissions, thirty-day readmission, reoperation, and death rates (LRYGB ICU 1.22%, readmission 2.42%, reoperation 6.19%, death 0.16%; LSG ICU 0.52%, readmission 0.88%, reoperation 3.11%, death 0.07%).
Our findings represent the first published study investigating the 2016 ACS-MBSAQIP database for laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy outcomes. It would appear LRYGB is favored for patients with increased preoperative comorbidity and associated challenges in the perioperative and postoperative course compared to LSG. Surgeon preference and familiarity with these techniques in addition to unique patient circumstances should be used as determinants in selecting the method of weight-loss surgery.