Gastric Sleeve Tied to Lower Risk for Subsequent Procedures

Patients undergoing vertical sleeve gastrectomy (VSG) appear to be less likely than matched patients undergoing Roux-en-Y gastric bypass (RYGB) to experience subsequent abdominal operative interventions, according to a study published online December in JAMA Network Open.

Kristina H. Lewis, M.D., from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues used a nationwide U.S. commercial insurance claims database to identify adults aged 18 to 64 years who underwent a first RYGB (4,476 patients) or VSG (8,551 patients) procedure during January 2010 through June 2017. Patients were matched on U.S. region, year of surgery, most recent presurgery body mass index category (based on diagnosis codes), and baseline type 2 diabetes.

The researchers reported that 41.9 percent of patients had at least two years of follow-up and 16.3 percent had at least four years of follow-up. During follow-up, the researchers found that patients undergoing VSG were less likely to have any subsequent operative intervention than the matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80). VSG patients were also less likely to undergo biliary procedures (aHR, 0.77), abdominal wall hernia repair (aHR, 0.60), other abdominal operations (aHR, 0.71), and endoscopy (aHR, 0.54) or have enteral access placed (aHR, 0.58). However, patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83) compared with RYGB.

"Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB versus VSG as part of shared decision-making around procedure choice," the authors write.

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