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Fewer interventions after sleeve gastrectomy vs. Roux-en-Y, real-world data show

Key clinical point: Sleeve gastrectomy is associated with significantly fewer postsurgical interventions and operations than is Roux-en-Y gastric bypass over a 5-year follow-up using real-world clinical data.

Major finding: Patients who underwent sleeve gastrectomy were less likely to undergo subsequent operations or interventions (hazard ratio, 0.72; 95% CI, 0.65-0.79; P less than .001).

Study details: Cohort study including long-term follow-up on 33,560 adults who underwent bariatric procedures between 2005 and 2015.

Disclosures: The Patient-Centered Outcomes Research Institute funded the work. The authors reported ties to Allurion, the National Institutes of Health, IFSO Latin America Chapter, and the Food and Drug Administration.

Citation:

Courcoulas A et al. JAMA Surg. 2020 Jan 15. doi: 10.1001/jamasurg.2019.5470.

Commentary:

This study by Courcoulas and colleagues adds to an established body of data showing that bariatric surgery is safe, according to authors of an invited commentary on the study.

More specifically, the study provides data that sleeve gastrectomy – which has become the most common bariatric procedure in the United States – is safe in the long term, said Anne P. Ehlers, MD, MPH, and Amir A. Ghaferi, MD, MS.

Barriers to surgery need to come down in response to the worsening public health crisis that these procedures address, according to Dr. Ehlers and Dr. Ghaferi.

“It is time we stop questioning the safety or efficacy of surgery and begin advocating for comprehensive obesity care for patients,” they said in their invited commentary.

Less than 1% of patients eligible for bariatric surgery undergo this “life-saving” treatment, they said, adding that obesity bias delays surgical referrals, while some “continue to fear” surgical risks, and decades-old guidelines restrict procedures to patients with higher body mass index.

The present study shows that sleeve gastrectomy is at least as safe, if not safer, than the Roux-en-Y gastric bypass procedure, said Dr. Ehlers and Dr. Ghaferi.

The study also answers the question of whether sleeve gastrectomy has an “unacceptably high” rate of gastroesophageal reflux disease (GERD) prompting revision surgeries, they said.

On the contrary, sleeve gastrectomy was associated with lower rates of reoperation, and lower rates of endoscopies, which almost always come before reoperations related to GERD, they explained.

Anne P. Ehlers, MD, MPH, and Amir A. Ghaferi, MD, MS, are with the department of surgery at the University of Michigan in Ann Arbor. They reported no conflicts of interests related to their invited commentary, which appears in JAMA Surgery .