I posted this on the VSG board and thought it may be worth posting here where there are a lot of pre-ops comparing their surgery choices...


http://www.ncbi.nlm.nih.gov/pubmed/21803660

Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

Topart P, Becouarn G, Ritz P.

Source

Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.

Abstract

BACKGROUND:

Since the introduction of the isolated sleeve gastrectomy in 1997, this procedure has gained immense popularity in the hopes of reducing the operative risks with a less complex operation. We reviewed our recent 2-year experience with bariatric surgery to compare the early outcomes of the 3 complex procedures routinely performed by our private practice at a single institution: sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD-DS).

METHODS:

The 30-day morbidity and 90-day mortality rates were retrospectively reviewed among a total of 507 primary bariatric procedures. The early postoperative outcomes of 360 RYGB, 88 SG, and 59 BPD-DS procedures performed during this period were compared.

RESULTS:

The patients weighed more in the BPD-DS and SG groups. The SG patients were significantly older than the RYGB and BPD-DS patients. Co-morbidities were significantly more frequent in the SG and BPD-DS patients. One patient died after RYGB but none did so after BPD-DS or SG. The global complication rate was significantly increased after BPD-DS (P = .0017) compared with RYGB; however, no difference was found between RYGB and SG, although bleeding was likely to appear more frequent, not only after BPD-DS, but also after SG compared with RYGB.

CONCLUSION:

Although no fatal outcomes occurred after SG, this procedure did not demonstrate a reduced risk of postoperative complications compared with RYGB with a significantly greater rate of bleeding. RYGB appears to be a relatively safe bariatric procedure, although the groups were not comparable in terms of the preoperative body mass index or co-morbidities, the exact role of which on postoperative morbidity remains controversial. Although the increased risk of RYGB to BPD-DS was confirmed, SG failed to live up to its "more benign" reputation.

Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Obviously, the groups cannot be compared apples for apples because there are distinct differences between them.  Sleeve patients in this study were older than RNY and DS with more co-morbids than RNY.   Still interesting...

What are your thoughts?

I shared my thoughts on the sleeve forum. And, I completely agree with Elizabeth. But, here's my thoughts on the general "study" information.

The  major complication rate with VSG is 1%.  1% compared to a 25% reoperation rate with the band, the high regain and complication stats with RNY. . . Hmmm still logical to go with the surgery that gives the LEAST amount of long term complications.  No one ever said VSG was benign.

I really don't understand the major issue. It's surgery, they're removing a large portion of a major organ. Why does anyone ever think that this surgery is more "benign" over the initial band placement?

The VSG has long since been proven to far less have long term risks vs. the band and RNY.

Also, gastrectomies for cancer and ulcer patients have been performed since the 1800's. Dig up some information on those surgeries, and see how low the long term risks with gastrectomies (partial or full). Compared to the band, even with a diseased organ, patients suffer less complications and long term side effects by having partial or complete removal of their stomachs.

The sleeve and DS groups had patients that weighed more, had more co-morbidites, and the sleeve group also had patients that were older. 

Those three things are huge factors in how well we do after surgery, so not having the groups be as similar as possible, make the information pretty useless to me.

In fact, it would leave me to just make my own assumptions, which would be that if the global complication rates the same for sleeve and RNY when the sleeve group had older, fatter, sicker people, then the sleeve group would fare much better than RNY if the ages, weights and co-morbs were actually similar.

I like to keep track of studies that apply to WLS and things that may help me some day (or someone else) but I won't bother looking this one up.

To me, it says...

"We made ground chicken burgers which were eaten by elderly Polish immigrants and we made planked salmon whch was eaten a mob of random-aged descendants of Leif Eriksson and we also made lots of California Rolls and those were eaten by pregnant Italian tourists and their spouses.  Most people thought it was pretty good, but that could have been because it was free.  No one died."

 

now I am hungry!!

LMAO!!!!

Awesome.

Exactly

Now please tell your husband that I haven't received my candy in the mail yet.

Bull****!!

All surgeries cause risk during the actural procedure and immediate recovery.  It is the long term risks that matter.  The sleeve RULES!!!

"Since the introduction of the isolated sleeve gastrectomy in 1997, this procedure has gained immense popularity in the hopes of reducing the operative risks with a less complex operation. "

Um, no. Just no. People don't get a sleeve because they think the actual surgery is less risky. (Or at least not primarily.) It's the LONG TERM risks that they are worried about.

So the very basis of the study is flawed.

The thing is, the major short-term risks of these surgeries depend on a number of factors. For example, the longer you are under anesthesia, the bigger your risks of having an anesthesia-related complication. So if you are comparing several different surgery types and one requires a 4 hour operation and the other a 45 min. operation and the study says there are no differences in post-op complications, I am immediately suspicious.