Weight loss surgery, also known as bariatric surgery, has become an increasingly popular option for individuals struggling with obesity. Two commonly performed procedures are laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (RYGB). The BEST trial recently conducted a randomized study comparing the safety and perioperative complications of these two procedures. This article aims to analyze and discuss the findings of the trial, shedding light on the similarities and differences in safety outcomes between laparoscopic sleeve gastrectomy and laparoscopic RYGB.
The BEST trial found that the incidence of any adverse event (AE) at 30 days did not significantly differ between laparoscopic sleeve gastrectomy and laparoscopic RYGB. The study included 1,735 patients, and the occurrence of AEs was observed in 4.6% of sleeve gastrectomy patients and 6.3% of RYGB patients. Furthermore, the rates of serious AEs were also similar between the two procedures, with 1.7% in the sleeve gastrectomy group and 2.7% in the RYGB group. None of the patients from either group died within 90 days post-surgery.
The only significant difference in serious AEs between the two procedures was the occurrence of small bowel obstruction. The study reported no cases of small bowel obstruction in the sleeve gastrectomy group, while six cases (0.7%) were observed in the RYGB group. The researchers attributed this outcome to the Lönroth surgical technique used in RYGB. It is crucial to note that this difference in adverse events is limited to small bowel obstruction and does not reflect a higher rate of overall complications in either procedure.
The study also compared the 30-day readmission rates and postoperative hospital stay between the two procedures. The rates of readmission were similar, with 3.1% for sleeve gastrectomy and 4% for RYGB. Additionally, the postoperative hospital stay was equivalent for both procedures, averaging one day. These findings indicate that the short-term outcomes, including readmission rates and hospital stay, are comparable between sleeve gastrectomy and RYGB.
A significant difference was observed in the average operating time for laparoscopic sleeve gastrectomy and laparoscopic RYGB. Sleeve gastrectomy had a significantly shorter operating time of 47 minutes compared to RYGB, which averaged 68 minutes. This discrepancy in operating time can be attributed to the higher complexity of RYGB. However, it is important to note that the length of the procedure does not seem to impact the overall safety and complications of the surgeries.
Based on the findings of the BEST trial, Dr. Suzanne Hedberg emphasizes that the short-term surgical risk should not be the deciding factor when choosing a bariatric procedure. Both laparoscopic sleeve gastrectomy and laparoscopic RYGB had low and very similar perioperative adverse event rates. Dr. Hedberg suggests that the long-term suitability of the procedure to each patient should be of higher relevance in the procedural choice. The long-term outcomes, including weight loss and serious adverse events, are essential factors to consider when selecting a surgical approach.
The BEST trial provides valuable insights into the safety and complications of laparoscopic sleeve gastrectomy and laparoscopic RYGB. The study demonstrates that both procedures yield comparable results in terms of perioperative adverse events and short-term outcomes such as readmission rates and hospital stay. While small bowel obstruction was more prevalent in RYGB, this specific difference should not overshadow the overall similarities in safety. As the study continues to track the patients for long-term outcomes, it will shed more light on the weight loss and serious adverse events 5 years after surgery. Ultimately, the decision between laparoscopic sleeve gastrectomy and laparoscopic RYGB should be based on the individual patient’s long-term suitability and goals.
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