Chaim Sheba Medical Center, affiliated with Tel Aviv University Sakler Medical School, Israel. 2. Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel. 3.
Assessment of Complications Following Primary Bariatric Surgery According to the Clavien-Dindo Classification Comparison between Sleeve Gastrectomy & Gastric Bypass D. Goitein1,2 , N. Sakran2,3, A. Szold2, A. Raziel2 1. Chaim Sheba Medical Center, affiliated with Tel Aviv University Sakler Medical School, Israel 2. Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel 3. Emek Medical Center, Afula, affiliated with Technion-Israel Institute of Technology, Haifa, Israel
Disclosures
None
Complications After Bariatric Surgrey Bariatric surgery is the mainstay treatment for morbid obesity Most Common procedures are LSG and LRYGBP
Trends
Nguyen et.al, JACS 2013
Trends
Lazzati et. al, SOARD 2013
Sleeve vs. Bypass
Sleeve vs. Bypass “Objective”
Excess weight (Pt. habitus) Medical Status Previous surgeries Eating habits Long-term results
“Subjective”
Safety
Trends “Pre-decided Patient” Surgeon experience or preference
Complication Classification/Reporting 1.
Major vs. Minor morbidity
A Major
– Requiring invasive interventions Minor – Not requiring invasive interventions
B Major
– Life threatening/Potentially Minor – not life threatening
C Major
– Leak, VTE, Bleed…. Minor – Dysphagia, Wound inf., Dehydration…
Complication Classification/Reporting 2.
Complication Type Leak Bleed VTE Cardiac Respiratory Etc…..
Leak
Pt. A
POD1-2 Normal. POD 3 typical drainage + positive blue-dye test. Drain left in place TPN Resolution
Pt. B
Discharged on POD 2. Readmitted POD 5: Fever, chills CT – collection + leak Drainage (OR or perc.) Sepsis ICU….
Bleeding
Pt. A
POD 1 – 200ml bloody drainage. Normotensive. Hemoglobin drop of 2gm%, stabilizes. DC
Pt. B
POD 1 – 200ml bloody drainage. Tachycardic, pale, sweating. 2U PC Hemoglobin , HoTN OR
Complication Classification/Reporting
Clavien-Dindo Classification of Surgical Complications Outcome-Management based
Patients & Methods Retrospective review of prospectively collected data 2006 – 2013 Primary LSG & LRYGBP Perioperative complications graded according to Clavien-Dindo LOS and Readmission rates recorded
Results LSG (n= 1978)
BMI 43.0kg/m2 (35-72) AGE 42y (19-71) Female 64% Comorbidities
LRYGBP (n= 478)
p - NS
43.1kg/m2 (35-65) 43y (21-68) 66% Comorbidities
Results - complications CD
LSG (n= 76; 3.8%)
LRYGBP (n= 23; 4.3%)
P (0.4)
1
15 (0.7%)
2 (0.4%)
0.6
2
32 (1.6%)
13 (2.7%)
0.15
3a
13 (0.6%)
5 (1%)
0.55
3b
10 (0.5%)
2 (0.4%)
0.9
4a
4 (0.2%)
1 (0.2%)
0.59
4b
2 (0.1%)
0
0.84
5
0
0
1
Results – cont. Median length of hospital stay was 2 days for both Readmission rate:
LSG - 2.1% LRYGBP - 1.8% (p= 0.9)
Conclusions
LSG is NOT “safer” than LRYGBP (In experienced hands) (at least perioperatively)
Better long-term results of LRYGBP (debatable)
Conclusions
Perhaps time for pendulum direction change….
