Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Risk-Adjusted Safety Profiles after Previous Fundoplication: A 499-Patient MBSAQIP Analysis

TL;DR

The study compares the safety of two weight-loss surgeries after a prior anti-reflux procedure, finding both are generally safe despite some differences in complication rates.

Contribution

This is the first large-scale analysis comparing sleeve gastrectomy and gastric bypass after prior fundoplication using a national database.

Findings

74.7% of patients had Roux-en-Y gastric bypass while 25.3% had sleeve gastrectomy after fundoplication.

Unadjusted complication rates were higher for gastric bypass (9.6%) compared to sleeve gastrectomy (4.0%).

After adjusting for baseline differences, procedure type was not a significant predictor of serious complications.

Abstract

Obesity and gastroesophageal reflux disease (GERD) frequently coexist and may necessitate surgical intervention when conservative management fails. While fundoplication is effective for GERD, many patients ultimately require metabolic and bariatric surgery (MBS) for obesity. The safety and prevalence of sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) after prior fundoplication remains poorly characterized.

To assess the prevalence and 30-day serious complication rates of SG and RYGB following fundoplication, and to identify independent predictors of adverse outcomes.

A retrospective analysis of the 2022–2023 MBSAQIP database identified 499 patients undergoing primary SG or RYGB after fundoplication. Outcomes assessed included leak, bleeding, reoperation, reintervention, cardiac events, pneumonia, kidney injury, thromboembolism, infection, or sepsis. Multivariable logistic regression was used to adjust for baseline differences.

Of 499 patients, 126 (25.3%) underwent SG (F-SG) and 373 (74.7%) underwent RYGB (F-RYGB). Concomitant paraesophageal hernia repair was more common in the F-RYGB group (54.2% vs. 26.2%, p < 0.001). Mean BMI was higher in F-SG (42.4 vs. 40.1 kg/m², p < 0.001). Weight gain and GERD were the leading indications for revisional bariatric surgery. F-RYGB was associated with longer operative times, hospital stay, and higher rates of reoperation, readmission, bowel obstruction, and serious complications (9.6% vs. 4.0%, p = 0.045). Rates of anastomotic leak, postoperative bleeding, and composite wound complications were low but numerically higher in F-RYGB, without statistical significance. In multivariate analysis, procedure type was not significantly associated with serious complications (OR 2.03, 95% CI 0.68–6.09, p = 0.207).

Both SG and RYGB appear to be safe and effective revisional options, and a history of fundoplication should not be considered a contraindication. Although RYGB was associated with longer operative times and higher early complication rates, multivariable analysis showed no significant difference in serious complications between the two procedures.

74.7% had RYGB; 25.3% underwent SG after failed fundoplication.Main indications were weight gain (43.1%) and GERD (32.1%).Unadjusted complications higher in RYGB vs. SG (9.6% vs. 4.0%, p = 0.045).After adjustment, RYGB was not a significant predictor of complications.

74.7% had RYGB; 25.3% underwent SG after failed fundoplication.

Main indications were weight gain (43.1%) and GERD (32.1%).

Unadjusted complications higher in RYGB vs. SG (9.6% vs. 4.0%, p = 0.045).

After adjustment, RYGB was not a significant predictor of complications.