Big New Sleeve Study; Not as Bad as the Band Not as Dangerous as the RNY
Ann Surg. 2011 Sep;254(3):410-422.
First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass.
*Department of Surgery, Massachusetts General Hospital. Boston, MA †Department of Surgery, University of Virginia Health System. Charlottesville, VA ‡Department of Surgery, Beth Israel Deaconess Medical Center. Boston, MA §Department of Surgery, University of California, Los Angeles Medical Center. Los Angeles, CA ¶American College of Surgeons, Chicago, IL **Department of Surgery, University of Colorado Hospital. Aurora, CO ††Department of Surgery, University of California, Irvine School of Medicine. Irvine, CA; and On behalf of the ACS-BSCN Advisory Committee.
To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) as compared to the laparoscopic adjustable gastric band (LAGB), the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the open Roux-en-Y gastric bypass (ORYGB) for the treatment of obesity and obesity-related diseases.
LSG is a newer procedure being done with increasing frequency. However, limited data are currently available comparing LSG to the other established procedures. We present the first prospective, multiinstitutional, nationwide, clinically rich, bariatric-specific data comparing sleeve gastrectomy to the adjustable gastric band, and the gastric bypass.
This is the initial report analyzing data from the American College of Surgeons-Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and 1-year outcomes including morbidity and mortality, readmissions, and reoperations as well as reduction in body mass index (BMI) and weight-related comorbidities.
One hundred nine hospitals submitted data for 28,616 patients, from July, 2007 to September, 2010. The LSG has higher risk-adjusted morbidity, readmission and reoperation/intervention rates compared to the LAGB, but lower reoperation/intervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB.
LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined.
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