Gastric bypass associated with higher risk of additional operations

Research from the Harvard Pilgrim Health Care Institute finds that gastric bypass is associated with a higher risk of additional operations or other invasive procedures, compared to a gastric sleeve procedure. The study, "Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a National US Commercial Insurance Claims Database," appears online December 18 in JAMA Network Open.

Bariatric surgery is the most effective weight loss treatment for patients with severe obesity. The surgery provides significant health benefits in terms of improvement in weight-related conditions such as diabetes and high blood pressure. However, after bariatric surgery, some patients require additional surgical procedures to deal with surgical complications or problems that arise as a result of weight loss. Avoiding these return trips to the operating room is a high priority for both patients and surgeons. Roux-en-Y gastric bypass (bypass) and vertical sleeve gastrectomy (sleeve) are the two most common bariatric procedures currently performed, yet few large studies have compared the risk of repeat surgeries or other kinds of invasive interventions after these procedures. Knowledge about risk of these outcomes could help patients and surgeons make a more informed choice between the two procedures.

Researchers used data from a large national health insurance plan to determine whether patients have greater risk of additional operations or procedures after the bypass versus sleeve procedures. The study population consisted of 13,027 U.S. adults age 18-64 years who underwent an initial bypass or sleeve procedure between 2010 and 2017. The researchers identified instances of new abdominal surgeries or other types of procedures after the initial bariatric surgery, and compared the risk of these additional procedures between bypass and sleeve patients. The study results showed that patients undergoing sleeve gastrectomy had a lower overall risk of subsequent operative and nonoperative interventions up to 4 years after their initial bariatric surgery.

"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," said Frank Wharam, senior author and Associate Professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. Dr. Kristina Lewis, first author and Assistant Professor at Wake Forest School of Medicine adds, "Bariatric surgery has definitely become much safer for patients over the years, but our findings underscore that there are still risks involved. Comparing risks between bariatric procedure types should be part of the shared decision making process with patients who are considering one of these surgeries."