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Early and late complications after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a nationwide
Johanne Gormsen1, Frederik Helgstrand2
1Department of Surgery, Zealand University Hospital, Køge, Denmark.
Background:
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are widely used procedures for severe obesity. While both procedures are effective, the long-term risk of major and minor complications remains uncertain.
Objectives:
To compare the incidence and risk factors for early and late complications following LRYGB and LSG.
Setting:
Nationwide population-based study utilizing Danish administrative registries.
Methods:
Inclusion of all patients undergoing primary LRYGB or LSG from 2008 to 2018 in Denmark. Data were obtained from national health registries, enabling long-term individual-level follow-up. Propensity-score matching was performed 1:2 to minimize baseline differences. Early (≤30 days) and late (>30 days) complications were classified as major and minor based on standardized criteria. Multivariate logistic and Cox regression models were used for assessment of risk factors.
Results:
Among 18,090 patients, 2851 LRYGB and 1468 LSG patients were included. After 5 years, 3231 (75%) patients were available for follow-up. The risks of early major and minor complications were comparable between groups (P = .155 and P = .163, respectively). LRYGB was associated with increased risk of late complications, both major (hazard ratio [HR] 3.33, 95% confidence interval [CI] 2.40-4.64, P < .001) and minor (HR 1.38, 95% CI 1.22-1.57, P < .001). LRYGB patients had higher rates of internal herniation, marginal ulcers, and nutritional deficiencies, while revisional surgery and cholelithiasis rates were higher after LSG.
Conclusion:
LRYGB and LSG are safe procedures with low rates of major complications; however, LRYGB is associated with higher long-term complication burden. These findings underscore the importance of individualized patient selection and structured follow-up for optimization of outcomes after bariatric surgery.
