El Chaar M, et al. - Using the MBSAQIP data registry, the researchers assessed the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures. They found that revisional stapling procedures were reliable. However, the rates of complications following revisional sleeve (RS) and revisional gastric bypass (RB) were twice as high compared to primary sleeve gastrectomy (PS) and primary gastric bypass (PB). Complications were more likely to be seen with RB vs RS.

Methods

• All the sleeve and gastric bypass cases were reviewed entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry.
• Sleeve and bypass patients who have had a previous bariatric procedure were identified.
• Researchers analyzed demographics and 30 day outcomes of all sleeve and gastric bypass subjects.
• Within group comparisons comparing PS and PB patients to RS and RB patients, respectively was conducted.
• Group comparisons comparing RS to RB patients was also conducted.

Results

• The aggregate number of subjects analyzed was 141,577 (98,292 or 69% sleeve patients and 43,285 or 31% gastric bypass patients).
• Ninety-two thousand, six hundred sixty-six (94%) had a PS and 5626 (6%) had RS among the sleeve patients.
• Thirty-nine thousand, five hundred sixty-seven (91%) had a PB and 3718 patients (9%) had RB among the bypass patients.
• It was noted that 30-day readmission rate of RS was significantly higher as compared to PS (4.1 vs 0.4%, p < 0.05).
• They discovered that the incidence of at least one complication requiring reoperation or reintervention within 30 days following RS was twice as high as compared to PS (1.9 and 2% for RS vs 0.9 and 1.1% for PS respectively, p < 0.05).
• For PS and RS, length of stay and 30 day mortality rates were the same.
• It was observed that 30-day readmission rate of RB as compared to PB was 8.3 vs 6.3% (p < 0.05).
• It was found that the incidence of at least one complication requiring reoperation or reintervention following RB was 3.9 and 4%, respectively vs 2.4 and 2.7% for PB (p < 0.05).
• Readmission rates and unplanned admission rates to the ICU were significantly higher for RB compared to RS (8.3 and 2% for RB vs 4.1 and 0.9% for RS respectively, p < 0.05).
• In addition, the incidence of at least one reoperation or one intervention following RB were significantly higher compared to RS (3.9 vs 1.9% and 4 vs 2% respectively, p < 0.05).