Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry

Surg Obes Relat Dis. 2018 Mar;14(3):264-269. doi: 10.1016/j.soard.2017.12.011. Epub 2018 Feb 8.


Background: Laparoscopic sleeve gastrectomy (LSG) has become popular due to its technical ease and excellent short-term results. Understanding the risk profile of LSG compared with the gold standard laparoscopic Roux-en-Y gastric bypass (LRYGB) is critical for patient selection.

Objectives: To use traditional regression techniques and random forest classification algorithms to compare LSG with LRYGB using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Data Registry.

Setting: United States.

Methods: Outcomes were leak, morbidity, and mortality within 30 days. Variable importance was assessed using random forest algorithms. Multivariate models were created in a training set and evaluated on the testing set with receiver operating characteristic curves. The adjusted odds of each outcome were compared.

Results: Of 134,142 patients, 93,062 (69%) underwent LSG and 41,080 (31%) underwent LRYGB. One hundred seventy-eight deaths occurred in 96 (.1%) of LSG patients compared with 82 (.2%) of LRYGB patients (P<.001). Morbidity occurred in 8% (5.8% in LSG versus 11.7% in LRYGB, P<.001). Leaks occurred in 1% (.8% in LSG versus 1.6% in LRYGB, P<.001). The most important predictors of all outcomes were body mass index, albumin, and age. In the adjusted multivariate models, LRYGB had higher odds of all complications (leak: odds ratio 2.10, P<.001; morbidity: odds ratio 2.02, P<.001; death: odds ratio 1.64, P<.01).

Conclusion: In the Metabolic and Bariatric Surgery Accreditation and Quality Improvements data registry for 2015, LSG had half the risk-adjusted odds of death, serious morbidity, and leak in the first 30 days compared with LRYGB.

Keywords: Laparoscopic Roux-en-Y gastric bypass; Laparoscopic sleeve gastrectomy; MBSAQIP; Perioperative complications.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anastomotic Leak / etiology
  • Anastomotic Leak / mortality
  • Female
  • Gastrectomy / adverse effects*
  • Gastrectomy / mortality
  • Gastric Bypass / adverse effects*
  • Gastric Bypass / mortality
  • Humans
  • Laparoscopy / adverse effects*
  • Laparoscopy / mortality
  • Male
  • Middle Aged
  • Obesity / mortality
  • Obesity / surgery
  • Patient Safety
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Prospective Studies
  • Registries
  • United States / epidemiology