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Gastric Bypass Versus Sleeve Gastrectomy

Patient Selection and Short-term Outcome of 47,101 Primary Operations from the Swedish, Norwegian, and Dutch National Quality Registries

Poelemeijer, Youri Q. M., MD*,†; Liem, Ronald S. L., MD‡,§; Våge, Villy, MD, PhD||; Mala, Tom, MD, PhD; Sundbom, Magnus, MD, PhD#; Ottosson, Johan, MD, PhD**; Nienhuijs, Simon W., MD, PhD††

doi: 10.1097/SLA.0000000000003279
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Mini Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of procedure. This study showed that both procedures were safe, with Roux-en-Y gastric bypass having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.

Objective: The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands.

Background: Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients.

Methods: Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied.

Results: A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).

One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG.

Conclusion: This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.

*Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, Netherlands

Leiden University Medical Center, Department of Surgery, Leiden, Netherlands

Groene Hart Hospital, Department of Surgery, Gouda, Netherlands

§Dutch Obesity Clinic, The Hague, Netherlands

||Scandinavian Obesity Surgery Registry, Bergen, Norway

Oslo University Hospital, Department of Gastrointestinal Surgery, Oslo, Norway

#Uppsala University, Department of Surgical Sciences, Uppsala, Sweden

**Örebro University Hospital, Department of Surgery, Örebro, Sweden

††Catharina Hospital, Department of Surgery, Eindhoven, Netherlands.

Reprints: Youri Q. M. Poelemeijer, MD, Leiden University Medical Center, Department of Surgery, Albinusdreef 2, 2333 ZA Leiden, Netherlands. E-mail: Y.Q.M.Poelemeijer@lumc.nl.

The authors declare no conflicts of interest.

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