Safety Profiles of RYGB vs Sleeve Gastrectomy After Prior Fundoplication

Overview

This retrospective analysis of 499 cases from the MBSAQIP database compares the perioperative safety of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with prior fundoplication. The study identifies rates of serious complications and mortality within 30 days post-surgery and evaluates risk factors associated with adverse outcomes.

Background

Gastroesophageal reflux disease (GERD) and obesity often coexist, with obesity exacerbating reflux symptoms. Fundoplication is the standard surgical treatment for refractory GERD but has higher failure rates in obese patients. Revisional surgery options include redo fundoplication, RYGB, and SG. RYGB offers dual benefits by addressing both reflux and obesity, while SG's role post-fundoplication remains controversial due to concerns about worsening GERD. Comparative safety data for these revisional procedures are limited, prompting this large multicenter analysis.

Data Highlights

Key Findings

• RYGB and SG were both performed as revisional bariatric procedures after prior fundoplication in a cohort of 499 patients.
• Serious complication rates within 30 days included anastomotic leak, bleeding, cardiac events, pneumonia, and venous thromboembolism.
• RYGB demonstrated acceptable perioperative morbidity and low mortality, consistent with prior literature.
• SG, while feasible, carries concerns regarding GERD exacerbation postoperatively.
• Multivariable logistic regression identified patient factors and procedure type as predictors of serious complications and mortality.
• Indications for revisional surgery varied and were categorized to inform surgical decision-making.

Clinical Implications

Surgeons should consider RYGB as a preferred revisional procedure after failed fundoplication in obese patients due to its dual benefit on reflux control and weight loss, along with a favorable safety profile. SG may be considered in selected patients but requires careful evaluation given potential GERD exacerbation. Comprehensive preoperative assessment and risk stratification are essential to optimize outcomes.

Conclusion

This large multicenter analysis supports the safety and efficacy of RYGB over SG in patients undergoing revisional bariatric surgery after prior fundoplication. These findings provide evidence-based guidance to tailor surgical approaches balancing safety and symptom control in this complex population.

References

1. Author/Source/Year -- Safety Profiles of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Prior Fundoplication