Laparoscopic SG, RYGB Carry Similar, Low Perioperative Risk
TOPLINE:
The perioperative risk is similar and low for both laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB); therefore, that risk should not be a deciding factor in the choice of method for adults undergoing primary bariatric surgery.
METHODOLOGY:
- For the registry-based, multicenter randomized BEST, investigators analyzed baseline and perioperative data for adults undergoing bariatric surgery in Sweden and Norway from 2015 to 2022.
- A total of 1735 patients (mean age, 43 years; 74% women) with a body mass index of 35-50 were included and randomly assigned to either laparoscopic SG (878) or laparoscopic RYGB (857).
- For the SG procedure, the laparoscopic sleeve included a vertical resection of the stomach along the curvature. The resection started 4 cm to 5 cm proximally from the pylorus and ended 1 cm from the esophagogastric angle.
- For RYGB, the laparoscopic antecolic, antegastric procedure included construction of a small gastric pouch. The gastrojejunostomy and jejunojejunostomy were created using a linear stapler and hand-sutured closure of the remaining opening.
- Perioperative complications were analyzed at 30 days, and mortality was assessed at 30 days and 90 days after surgery.
TAKEAWAY:
- The mean operating time was shorter for SG vs RYGB (47.3 vs 67.7 min).
- The median postoperative hospital stay was 1.3 days in both groups.
- The 30-day readmission rate was 3.1% after SG and 4% after RYGB.
- At 30 days, the incidence of any adverse event was 40 (4.6%) with SG and 54 (6.3%) with RYGB (odds ratio [OR], 0.71), and the incidence of serious adverse events was 15 (1.7%) with SG and 23 (2.7%) with RYGB (OR, 0.63).
- There was no 90-day mortality.
IN PRACTICE:
“In this large randomized clinical trial comparing SG and RYGB, we found low rates of perioperative complications without statistical significance between groups,” the authors wrote. “We therefore suggest that the perioperative risk should be of limited focus in the choice between SG or RYGB.”
SOURCE:
The study was led by Suzanne Hedberg, MD, PhD, University of Gothenburg, Gothenburg, Sweden, and colleagues and published online on January 30, 2024, in JAMA Network Open.
LIMITATIONS:
The generalizability of BEST may be limited in that only 12% of eligible patients participated, there were no data on ethnicity, and the upper BMI limit was 50. In addition, for RYGB, a standardized antecolic, antegastric RYGB construction was used, which may limit the generalizability to surgical communities using other techniques for RYGB.
DISCLOSURES:
This work was supported by the Swedish Research Council (Medicine and Health), Region Västra Götaland, the Healthcare Committee, Agreement Concerning Research and Education of Doctors, and the Erling-Persson Foundation. For disclosures for Hedberg and coauthors, see the full paper.
