American Surgical Association

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First Report from the American College of Surgeons - Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy (LSG) Has Morbidity and Effectiveness Positioned Between the Band and the Bypass.
Matthew M Hutter, MD*1, Bruce D Schirmer, MD2, Daniel B Jones, MD3, Clifford Y Ko, MD4, Mark E Cohen, MD*5, Ryan P Merkow, MD*5, Ninh T Nguyen, MD*6
1Massachusetts General Hospital, Boston, MA;2University of Virginia Health System, Charlottesville, VA;3Beth Israel Deaconess Medical Center, Boston, MA;4University of California Los Angeles Medical Center, Los Angeles, CA;5American College of Surgeons, Chicago, IL;6University of California Irvine Medical Center, Irvine, CA

OBJECTIVE: Laparoscopic sleeve gastrectomy (LSG) is a newer procedure being done with increasing frequency for the treatment of morbid obesity and metabolic diseases. However, limited data are currently available. We present the first multi-institutional, nationwide, clinically-rich, bariatric-specific data comparing LSG to the Laparoscopic Adjustable Gastric Band(LAGB), Laparoscopic Roux-en-Y Gastric Bypass(LRYGB) and Open Roux-en-Y Gastric Bypass(ORYGB).

METHODS: This is the initial report analyzing data from the American College of Surgeons - Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and one-year outcomes including morbidity and mortality, as well as reduction in body mass index(BMI).
RESULTS: 109 hospitals submitted data for 28,616 patients, from 7/2007 to 9/2010. The LSG has higher risk-adjusted morbidity and readmission rates compared to the LAGB, but lower readmission and reoperation/reintervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI for the LSG also lies between those of the LAGB and the LRYGB/ORYGB. (See below.)
CONCLUSION: LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB. Ongoing nationwide data collection should provide critical information about long-term comparative effectiveness.
LSG
n=944
LAGB
n=12,193
LRYGB
n=14,491
ORYGB
n=988
30-day Mortality
. OR (95% CI)
0.11%
1 (referent)
0.05%
0.67 (0.08-5.65)
0.14%
1.62 (0.22 - 12.13)
0.71%
6.84 (0.83 - 56.29)
1-year Mortality
. OR (95% CI)
0.21%
1 (referent)
0.08%
0.53 (0.11 - 2.42)
0.34%
1.77 (0.43 - 7.33)
1.11%
4.29 (0.94 - 19.57)
Morbidity
. OR (95% CI)
5.61%
1 (referent)
1.44%
0.29 (0.21 - 0.40)
5.91%
1.06 (0.79 - 1.41)
14.98%
2.55 (1.83 - 3.55)
Readmission
. OR (95% CI)
7.63%
1 (referent)
4.05%
0.57 (0.44 - 0.74)
11.66%
1.64 (1.28 - 2.11)
16.30%
2.14 (1.59 - 2.89)
Reoperatio/intervention
. OR (95% CI)
5.51%
1 (referent)
4.59%
0.92 (0.68 - 1.23)
13.56%
2.73 (2.05 - 3.63)
14.07%
2.58 (1.89 - 3.61)


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