RYGB Patients Face Higher Risk of Additional Operations

A new study suggests that patients undergoing vertical sleeve gastrectomy (VSG) have a lower risk of subsequent operative intervention than those undergoing Roux-en-Y gastric bypass (RYGB).

Researchers at Harvard Medical School (HMS; Boston, MA, USA), Wake Forest School of Medicine (Winston-Salem, NC, USA), and other institutions used data from a U.S. national insurance claims database of adults who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017. The final weighted matched sample included 4,476 patients undergoing RYGB and 8,551 patients undergoing VSG, with the primary outcome being any abdominal operative intervention after the index procedure. Secondary outcomes included biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, other abdominal operations, and endoscopy and enteral access.

The results revealed that in patients followed up for up to four years after surgery, those undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB. They were similarly less likely to undergo biliary procedures, abdominal wall hernia repair, other abdominal operations, and endoscopy or enteral access placed. The patients undergoing VSG were also more likely to undergo bariatric conversion or revision. The study was published on December 18, 2019, in JAMA Network Open.

“Patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures,” concluded senior author James Wharam, BCh, MPH, of HMS, and colleagues. “Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB. It's important for patients to understand not only the many benefits of bariatric surgery, but also the risks, including the possible need for more surgery down the road.”

VSG is a restrictive form of weight loss surgery intended for the morbidly obese which reduces the size of the stomach by removing the lateral 2/3 of the stomach with a stapling device. While the stomach is drastically reduced in size, function is preserved, with no malabsorption of nutrients and supplements. The procedure avoids problems associated with bypass forms of weight loss surgery, including anemia, intestinal obstruction or blockage, osteoporosis, and protein and vitamin deficiency, and since about 100-200 ml of stomach capacity is maintained, there are very few restrictions on food consumption.

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