title: Laparoscopic Roux-en-Y gastric bypass patients have an increased lifetime risk of repeat operations when compared to laparoscopic sleeve gastrectomy patients.
abstract: BACKGROUND
  Although long-term data have been published on the complications after laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG) is a relatively new procedure without a well-established long-term procedure-related morbidity profile. Our aim was to compare the 6-year data on re-operations occurring after and related to LRYGB versus LSG at a large academic bariatric center.
  
  
  METHODS
  Retrospective review of all the bariatric procedures at the Massachusetts General Hospital between 2009 and 2014.
  
  
  RESULTS
  A total of 934 LRYGB and 553 LSG were performed. There were no significant differences in the gender, age, or BMI of the patients at the time of their index operations (p > 0.05 for all). A higher percentage of LRYGB patients required cholecystectomy as compared to LSG patients (5 vs. 2 %, X (2) = 8.63, p < 0.01). There was also a significant difference in the proportion of patients requiring re-operations for other reasons following LRYGB as compared to LSG (6.9 vs. 0.9 %, X (2) = 27.8, p < 0.01). A total of 32.8 % of these bypass patients underwent more than one re-operation, with a relative risk of 11.5 (95 % CI 4.69-28.5) as compared to those undergoing SG. A total of 9.3 % of secondary operations occurred at a mean of 1 month after the LRYGB for functional obstruction, with most of these cases related to a technical error. Other re-operations occurred in a delayed fashion, without a clearly identifiable intra-abdominal source in 22.2 %, due to adhesive bowel obstruction in 17.6 %, and internal hernia in 15.7 %. Non-healing ulcers and intussusception were responsible for a small percentage of re-operations (3.7 and 2.8 %).
  
  
  CONCLUSIONS
  SG is associated with a relatively low rate of re-operations, while patients after LRYGB are at a significant long-term risk for multiple operative procedures.
authors: Massachusetts General Hospital, 15 Parkman Street, WAC 460, Boston, MA, 02114, USA. yulia.zak@gmail.com.
authors: Yulia
authors: Y
authors: Zak
authors: MGH Learning Lab, Massachusetts General Hospital, 3 Hawthorne Place, Suite 105, Boston, MA, 02114, USA.
authors: Emil
authors: E
authors: Petrusa
authors: Massachusetts General Hospital, 15 Parkman Street, WAC 460, Boston, MA, 02114, USA. dgee@partners.org.
authors: Denise W
authors: DW
authors: Gee
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk
keywords: Complications; Outcomes; Re-operations; Roux-en-Y gastric bypass; Sleeve gastrectomy