Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up.
Bariatric surgery
Gastroesophageal reflux disease
Long-term results
Revisional surgery
Sleeve gastrectomy
Journal
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
ISSN: 1878-7533
Titre abrégé: Surg Obes Relat Dis
Pays: United States
ID NLM: 101233161
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
24
02
2020
revised:
24
04
2020
accepted:
16
05
2020
pubmed:
9
7
2020
medline:
28
4
2021
entrez:
9
7
2020
Statut:
ppublish
Résumé
Sleeve gastrectomy is the most common bariatric procedure worldwide. Several studies report good short- and midterm results. However, recent studies report alarming long-term outcomes, in particular about the revision rate. The aim of this study is the assessment of the revisional rate after sleeve gastrectomy and the analysis of most common reasons for surgical conversion and early complications. This study is based on a national claims database comprehensive of all bariatric procedures performed in a 10-year period. The French Programme De Médicalisation des Systèmes d'Information database was used to identify all patients who underwent sleeve gastrectomy between 2008 and 2018. Codes for diagnoses and procedures were used to describe the reason for and the morbidity of revision surgeries. Multivariate Cox proportional hazard regression analysis was performed to compare the risk of having a revision procedure. During the analyzed period, a total of 224,718 sleeve gastrectomies were performed. The rate of revision surgery after sleeve gastrectomy was 4.7%, 7.5%, and 12.2%, at 5, 7, and 10 years post procedure, respectively. A history of gastric banding was associated with a higher risk of revision (hazard ratio, 2.81; 95% CI, 2.66-2.95; P < .001). The most common revision procedure was gastric bypass (75.2%), followed by resleeve (18.7%). The main reasons for revision surgery were persistence of obesity (87.0%) and gastroesophageal reflux disease (5.2%). After revision surgery, we observed the following complications: 5.1% gastric leak, 18% bleeding, and reoperation rate of 6.4%. This study suggests that a large number of patients who initially underwent a sleeve gastrectomy will undergo a revisional surgery. This information should be considered in the initial choice of the bariatric procedure, and patients should be informed of the mid- and long-term risks.
Sections du résumé
BACKGROUND
BACKGROUND
Sleeve gastrectomy is the most common bariatric procedure worldwide. Several studies report good short- and midterm results. However, recent studies report alarming long-term outcomes, in particular about the revision rate.
OBJECTIVES
OBJECTIVE
The aim of this study is the assessment of the revisional rate after sleeve gastrectomy and the analysis of most common reasons for surgical conversion and early complications.
SETTING
METHODS
This study is based on a national claims database comprehensive of all bariatric procedures performed in a 10-year period.
METHODS
METHODS
The French Programme De Médicalisation des Systèmes d'Information database was used to identify all patients who underwent sleeve gastrectomy between 2008 and 2018. Codes for diagnoses and procedures were used to describe the reason for and the morbidity of revision surgeries. Multivariate Cox proportional hazard regression analysis was performed to compare the risk of having a revision procedure.
RESULTS
RESULTS
During the analyzed period, a total of 224,718 sleeve gastrectomies were performed. The rate of revision surgery after sleeve gastrectomy was 4.7%, 7.5%, and 12.2%, at 5, 7, and 10 years post procedure, respectively. A history of gastric banding was associated with a higher risk of revision (hazard ratio, 2.81; 95% CI, 2.66-2.95; P < .001). The most common revision procedure was gastric bypass (75.2%), followed by resleeve (18.7%). The main reasons for revision surgery were persistence of obesity (87.0%) and gastroesophageal reflux disease (5.2%). After revision surgery, we observed the following complications: 5.1% gastric leak, 18% bleeding, and reoperation rate of 6.4%.
CONCLUSIONS
CONCLUSIONS
This study suggests that a large number of patients who initially underwent a sleeve gastrectomy will undergo a revisional surgery. This information should be considered in the initial choice of the bariatric procedure, and patients should be informed of the mid- and long-term risks.
Identifiants
pubmed: 32636173
pii: S1550-7289(20)30302-6
doi: 10.1016/j.soard.2020.05.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1497-1504Informations de copyright
Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.