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Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis

Published:September 19, 2014DOI:https://doi.org/10.1016/j.amjsurg.2014.08.002

      Abstract

      Background

      Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the current “gold standard” bariatric procedure in the United States. Laparoscopic sleeve gastrectomy (LSG) has recently become a commonly performed procedure for many reasons, including patients' perception that LSG has less complexity and invasiveness, and lower risk. Our objective was to review the literature and compare the leak rates, morbidity, and mortality for LRYGB versus LSG.

      Methods

      Publications from 2002 to 2012 with n greater than or equal to 25 and postoperative leak rate reported were included. Statistical analysis included chi-square according to patient number.

      Results

      Twenty-eight (10,906 patients) LRYGB and 33 (4,816 patients) LSG articles were evaluated. Leak rates after LRYGB versus LSG were 1.9% (n = 206) versus 2.3% (n = 110), respectively (P = .077). Mortality rates were .4% (27/7,117) for LRYGB and .2% (7/3,594) for LSG (P = .110). Timing from surgery to leak ranged from 1 to 12 days for LRYGB versus 1 to 35 days for LSG.

      Conclusions

      Leak and mortality rates after LRYGB and LSG were comparable. The appropriate procedure should be tailored based on patient factors, comorbidities, patient and surgeon comfort level, surgeon experience, and institutional outcomes.

      Keywords

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      References

        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • et al.
        Prevalence of Obesity in the United States, 2009–2010. NCHS Data Brief, No 82.
        National Center for Health Statistics, Hyattsville, MD2012
      1. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement.
        Am J Clin Nutr. 1992; 55: 615S-619S
        • Stefater M.A.
        • Kohli R.
        • Inge T.H.
        Advances in the surgical treatment of morbid obesity.
        Mol Aspects Med. 2013; 34: 84-94
        • Dumon K.R.
        • Murayama K.M.
        Bariatric surgery outcomes.
        Surg Clin North Am. 2011; 91: 1313-1338
        • Al Harakeh A.B.
        Complications of laparoscopic Roux-en-Y gastric bypass.
        Surg Clin North Am. 2011; 91: 1225-1237
        • Gilbert E.W.
        • Wolfe B.M.
        Bariatric surgery for the management of obesity: state of the field.
        Plast Reconstr Surg. 2012; 130: 948-954
        • Mason E.E.
        • Ito C.
        Gastric bypass in obesity.
        Surg Clin North Am. 1967; 47: 1345-1351
        • Wittgrove A.C.
        • Clark G.W.
        • Tremblay L.S.
        Laparoscopic gastric bypass Roux-en-Y: preliminary report of five cases.
        Obes Surg. 1994; 4: 353-357
        • Ren C.J.
        • Patterson E.
        • Gagner M.
        Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients.
        Obes Surg. 2000; 10: 514-523
        • Brethauer S.A.
        Sleeve gastrectomy.
        Surg Clin North Am. 2011; 91: 1265-1279
        • Aurora A.R.
        • Khaitan L.
        • Saber A.A.
        Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients.
        Surg Endosc. 2012; 26: 1509-1515
        • Cottam D.
        • Qureshi F.G.
        • Mattar S.G.
        • et al.
        Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity.
        Surg Endosc. 2006; 20: 859-863
        • Weiner R.A.
        • Weiner S.
        • Pomhoff I.
        • et al.
        Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume.
        Obes Surg. 2007; 17: 1297-1305
        • Givon-Madhala O.
        • Spector R.
        • Wasserberg N.
        • et al.
        Technical aspects of laparoscopic sleeve gastrectomy in 25 morbidly obese patients.
        Obes Surg. 2007; 17: 722-727
        • Rubin M.
        • Yehoshua R.T.
        • Stein M.
        • et al.
        Laparoscopic sleeve gastrectomy with minimal morbidity. Early results in 120 morbidly obese patients.
        Obes Surg. 2008; 18: 1567-1570
        • Mui W.L.
        • Ng E.K.
        • Tsung B.Y.
        • et al.
        Laparoscopic sleeve gastrectomy in ethnic obese Chinese.
        Obes Surg. 2008; 18: 1571-1574
        • Kasalicky M.
        • Michalsky D.
        • Housova J.
        • et al.
        Laparoscopic sleeve gastrectomy without an over-sewing of the staple line.
        Obes Surg. 2008; 18: 1257-1262
        • Felberbauer F.X.
        • Langer F.
        • Shakeri-Manesch S.
        • et al.
        Laparoscopic sleeve gastrectomy as an isolated bariatric procedure: intermediate-term results from a large series in three Austrian centers.
        Obes Surg. 2008; 18: 814-818
        • Tagaya N.
        • Kasama K.
        • Kikkawa R.
        • et al.
        Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity.
        Obes Surg. 2009; 19: 1371-1376
        • Casella G.
        • Soricelli E.
        • Rizzello M.
        • et al.
        Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy.
        Obes Surg. 2009; 19: 821-826
        • Goitein D.
        • Goitein O.
        • Feigin A.
        • et al.
        Sleeve gastrectomy: radiologic patterns after surgery.
        Surg Endosc. 2009; 23: 1559-1563
        • Arias E.
        • Martínez P.R.
        • Ka Ming Li V.
        • et al.
        Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity.
        Obes Surg. 2009; 19: 544-548
        • Frezza E.E.
        • Reddy S.
        • Gee L.L.
        • et al.
        Complications after sleeve gastrectomy for morbid obesity.
        Obes Surg. 2009; 19: 684-687
        • Lacy A.
        • Ibarzabal A.
        • Pando E.
        • et al.
        Revisional surgery after sleeve gastrectomy.
        Surg Laparosc Endosc Percutan Tech. 2010; 20: 351-356
        • Ser K.H.
        • Lee W.J.
        • Lee Y.C.
        • et al.
        Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage.
        Surg Endosc. 2010; 24: 2253-2259
        • Rice R.D.
        • Simon T.E.
        • Seery J.M.
        • et al.
        Laparoscopic sleeve gastrectomy: outcomes at a military training center.
        Am Surg. 2010; 76: 835-840
        • Csendes A.
        • Braghetto I.
        • León P.
        • et al.
        Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity.
        J Gastrointest Surg. 2010; 14: 1343-1348
        • Nienhuijs S.W.
        • de Zoete J.P.
        • Berende C.A.
        • et al.
        Evaluation of laparoscopic sleeve gastrectomy on weight loss and co-morbidity.
        Int J Surg. 2010; 8: 302-304
        • Jacobs M.
        • Bisland W.
        • Gomez E.
        • et al.
        Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results.
        Surg Endosc. 2010; 24: 781-785
        • Dapri G.
        • Cadière G.B.
        • Himpens J.
        Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques.
        Obes Surg. 2010; 20: 462-467
        • Sammour T.
        • Hill A.G.
        • Singh P.
        • et al.
        Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure.
        Obes Surg. 2010; 20: 271-275
        • Armstrong J.
        • O'Malley S.P.
        Outcomes of sleeve gastrectomy for morbid obesity: a safe and effective procedure?.
        Int J Surg. 2010; 8: 69-71
        • Gluck B.
        • Movitz B.
        • Jansma S.
        • et al.
        Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure for the lower BMI (35.0-43.0 kg/m2) population.
        Obes Surg. 2011; 21: 1168-1171
        • Alley J.B.
        • Fenton S.J.
        • Harnisch M.C.
        • et al.
        Integrated bioabsorbable tissue reinforcement in laparoscopic sleeve gastrectomy.
        Obes Surg. 2011; 21: 1311-1315
        • Simon T.E.
        • Scott J.A.
        • Brockmeyer J.R.
        • et al.
        Comparison of staple-line leakage and hemorrhage in patients undergoing laparoscopic sleeve gastrectomy with or without Seamguard.
        Am Surg. 2011; 77: 1665-1668
        • Gagnière J.
        • Slim K.
        • Launay-Savary M.V.
        • et al.
        Previous gastric banding increases morbidity and gastric leaks after laparoscopic sleeve gastrectomy for obesity.
        J Visc Surg. 2011; 148: e205-e209
        • Stamou K.M.
        • Menenakos E.
        • Dardamanis D.
        • et al.
        Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy.
        Surg Endosc. 2011; 25: 3526-3530
        • Musella M.
        • Milone M.
        • Bellini M.
        • et al.
        Laparoscopic sleeve gastrectomy. Do we need to oversew the staple line?.
        Ann Ital Chir. 2011; 82: 273-277
        • Angrisani L.
        • Cutolo P.P.
        • Buchwald J.N.
        • et al.
        Laparoscopic reinforced sleeve gastrectomy: early results and complications.
        Obes Surg. 2011; 21: 783-793
        • Albanopoulos K.
        • Alevizos L.
        • Linardoutsos D.
        • et al.
        Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients.
        Obes Surg. 2011; 21: 687-691
        • Behrens C.
        • Tang B.Q.
        • Amson B.J.
        Early results of a Canadian laparoscopic sleeve gastrectomy experience.
        Can J Surg. 2011; 54: 138-143
        • Triantafyllidis G.
        • Lazoura O.
        • Sioka E.
        • et al.
        Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls.
        Obes Surg. 2011; 21: 473-478
        • Bellanger D.E.
        • Greenway F.L.
        Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results and technical considerations.
        Obes Surg. 2011; 21: 146-150
        • Daskalakis M.
        • Berdan Y.
        • Theodoridou S.
        • et al.
        Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy.
        Surg Endosc. 2011; 25: 88-97
        • Oliak D.
        • Ballantyne G.H.
        • Davies R.J.
        • et al.
        Short-term results of laparoscopic gastric bypass in patients with BMI > or = 60.
        Obes Surg. 2002; 12: 643-647
        • Blachar A.
        • Federle M.P.
        • Pealer K.M.
        • et al.
        Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings.
        Radiology. 2002; 223: 625-632
        • Champion J.K.
        • Williams M.D.
        Prospective randomized comparison of linear staplers during laparoscopic Roux-en-Y gastric bypass.
        Obes Surg. 2003; 13: 855-859
        • Olbers T.
        • Lönroth H.
        • Fagevik-Olsén M.
        • et al.
        Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome.
        Obes Surg. 2003; 13: 364-370
        • Shope T.R.
        • Cooney R.N.
        • McLeod J.
        • et al.
        Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis.
        Obes Surg. 2003; 13: 355-359
        • Kligman M.D.
        • Thomas C.
        • Saxe J.
        Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypass.
        Am Surg. 2003; 69: 304-309
        • Papasavas P.K.
        • Caushaj P.F.
        • McCormick J.T.
        • et al.
        Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity.
        Surg Endosc. 2003; 17: 610-614
        • Suter M.
        • Giusti V.
        • Héraief E.
        • et al.
        Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience.
        Surg Endosc. 2003; 17: 603-609
        • Artuso D.
        • Wayne M.
        • Kaul A.
        • et al.
        Extremely high body mass index is not a contraindication to laparoscopic gastric bypass.
        Obes Surg. 2004; 14: 750-754
        • Gould J.C.
        • Garren M.J.
        • Starling J.R.
        Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program.
        Obes Surg. 2004; 14: 618-625
        • Dresel A.
        • Kuhn J.A.
        • McCarty T.M.
        Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients.
        Am J Surg. 2004; 187: 230-232
        • Luján J.A.
        • Frutos M.D.
        • Hernández Q.
        • et al.
        Experience with the circular stapler for the gastrojejunostomy in laparoscopic gastric bypass (350 cases).
        Obes Surg. 2005; 15: 1096-1102
        • Lublin M.
        • Lyass S.
        • Lahmann B.
        • et al.
        Leveling the learning curve for laparoscopic bariatric surgery.
        Surg Endosc. 2005; 19: 845-848
        • Ballesta-López C.
        • Poves I.
        • Cabrera M.
        • et al.
        Learning curve for laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomosis: analysis of first 600 consecutive patients.
        Surg Endosc. 2005; 19: 519-524
        • Kothari S.N.
        • Boyd W.C.
        • Larson C.A.
        • et al.
        Training of a minimally invasive bariatric surgeon: are laparoscopic fellowships the answer?.
        Obes Surg. 2005; 15: 323-329
        • Leifsson B.G.
        • Gislason H.G.
        Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients.
        Obes Surg. 2005; 15: 35-42
        • Gonzalez R.
        • Haines K.
        • Gallagher S.F.
        • et al.
        Does experience preclude leaks in laparoscopic gastric bypass?.
        Surg Endosc. 2006; 20: 1687-1692
        • Szomstein S.
        • Whipple O.C.
        • Zundel N.
        • et al.
        Laparoscopic Roux-en-Y gastric bypass with linear cutter technique: comparison of four-row versus six-row cartridge in creation of anastomosis.
        Surg Obes Relat Dis. 2006; 2: 431-434
        • Suggs W.J.
        • Kouli W.
        • Lupovici M.
        • et al.
        Complications at gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers.
        Surg Obes Relat Dis. 2007; 3: 508-514
        • Kligman M.D.
        Intraoperative endoscopic pneumatic testing for gastrojejunal anastomotic integrity during laparoscopic Roux-en-Y gastric bypass.
        Surg Endosc. 2007; 21: 1403-1405
        • Breaux J.A.
        • Kennedy C.I.
        • Richardson W.S.
        Advanced laparoscopic skills decrease the learning curve for laparoscopic Roux-en-Y gastric bypass.
        Surg Endosc. 2007; 21: 985-988
        • Lee S.
        • Carmody B.
        • Wolfe L.
        • et al.
        Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases.
        J Gastrointest Surg. 2007; 11: 708-713
        • Raman R.
        • Raman B.
        • Raman P.
        • et al.
        Abnormal findings on routine upper GI series following laparoscopic Roux-en-Y gastric bypass.
        Obes Surg. 2007; 17: 311-316
        • Sekhar N.
        • Torquati A.
        • Youssef Y.
        • et al.
        A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period.
        Surg Endosc. 2007; 21: 665-668
        • Madan A.K.
        • Stoecklein H.H.
        • Ternovits C.A.
        • et al.
        Predictive value of upper gastrointestinal studies versus clinical signs for gastrointestinal leaks after laparoscopic gastric bypass.
        Surg Endosc. 2007; 21: 194-196
        • Shikora S.A.
        • Kim J.J.
        • Tarnoff M.E.
        Comparison of permanent and nonpermanent staple line buttressing materials for linear gastric staple lines during laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2008; 4: 729-734
        • Jensen C.
        • Tejirian T.
        • Lewis C.
        • et al.
        Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2008; 4: 512-514
        • Efthimiou E.
        • Al-Sabah S.
        • Sampalis J.S.
        • et al.
        Fibrin sealant associated with increased body temperature and leukocytosis after laparoscopic gastric bypass.
        Surg Obes Relat Dis. 2010; 6: 46-49
        • Gagner M.
        • Deitel M.
        • Erickson A.L.
        • et al.
        Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy.
        Obes Surg. 2013; 23: 2013-2017
        • ASMBS Clinical Issues Committee
        Updated position statement on sleeve gastrectomy as a bariatric procedure.
        Surg Obes Relat Dis. 2012; 8: e21-e26
        • Podnos Y.D.
        • Jimenez J.C.
        • Wilson S.E.
        • et al.
        Complications after laparoscopic gastric bypass: a review of 3464 cases.
        Arch Surg. 2003; 138: 957-961
        • Kothari S.N.
        • Kallies K.J.
        • Mathiason M.A.
        • et al.
        Excellent laparoscopic gastric bypass outcomes can be achieved at a community-based training hospital with moderate case volume.
        Ann Surg. 2010; 252: 43-49