Key result
Sleeve gastrectomy was associated with a significantly higher risk of failing to achieve >50% excess weight loss at 2 years compared to gastric bypass (23.0% vs 8.5%, OR 4.46).
Why the study?
Revisional surgery is a second-line treatment option after sleeve gastrectomy and gastric bypass, but the theoretical need for revisional surgery applying indication benchmarks remained to be analyzed.
Does sleeve gastrectomy compared to gastric bypass increase the theoretical need for revisional bariatric surgery in patients with obesity?
Cohort (n=60,426)
Yes
Does sleeve gastrectomy compared to gastric bypass increase the theoretical need for revisional bariatric surgery in patients with obesity?
Odds Ratio: 4.46 (95% CI 4.04–4.93)
Absolute Event Rate: 23% vs 8.5%
p-value: p=<0.001
Sleeve gastrectomy is associated with a significantly higher risk of weight non-response and theoretical need for revisional surgery compared to gastric bypass at 2 years.
SG associated with higher weight non-response and revisional criteria vs GBP; leaves open impact on actual reoperation rates.
BACKGROUND: Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. The aim was to analyze the theoretical need for revisional surgery after SG and GBP when applying four indication benchmarks. METHOD: Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. excess weight loss (%EWL) < 50%, 2. weight regain of more than 10 kg after nadir, 3. fulfillment of previous IFSO-guidelines, or 4. ADA criteria for bariatric metabolic surgery 2 years after primary surgery. RESULTS: A total of 60,426 individuals were included in the study (SG: n = 7856 and GBP: n = 52,570). Compared to patients in the GBP group, more SG patients failed to achieve a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), and more often fulfilled the IFSO criteria (8.0% versus 4.5%, p < .001) or the ADA criteria (3.3% versus 1.8%, p < 001) at the 2-year follow-up. CONCLUSION: SG is associated with a higher risk for weight non-response compared to GBP. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments are necessary.
No takes yet. Share an insight, caveat, or question.
Axer et al. (2023) conducted a cohort in Obesity (n=60,426). Sleeve gastrectomy vs. Gastric bypass was evaluated on Excess weight loss (%EWL) < 50% at 2 years (OR 4.46, 95% CI 4.04-4.93, p=<0.001). Sleeve gastrectomy was associated with a significantly higher risk of failing to achieve >50% excess weight loss at 2 years compared to gastric bypass (23.0% vs 8.5%, OR 4.46).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: