Background

Roux-en-Y gastric bypass (RYGB) is the gold standard procedure for treating severe obesity. However, despite its durability, a subset of patients will need revisional surgery for weight regain. A potential intervention after RYGB is Roux-en-Y limb lengthening (RYLL), although current evidence understanding the safety of RYLL is scarce. The objective of this study was to compare the 30-day rate of serious complications and mortality of RYLL to primary RYGB.

Methods

Patients undergoing RYLL and RYGB were identified from the 2020 and 2021 MBSAQIP databases. Baseline characteristics, 30-day rate of serious complications and mortality were analyzed

Results

A total of 86,990 (99.5%) patients underwent RYGB and 455 (0.5%) RYLL. Patients undergoing RYGB were younger (44.4 vs 49.8 years, p<0.001) but had higher body mass index at the time of surgery (45.5 vs 41.8 kg/m2, p<0.001) and higher rates of comorbidities including diabetes (30.0 vs 13.6%, p<0.001). RYGB and RYLL had similar operative times (125.3 vs 123.2 minutes, p=0.5). There were no statistical differences between cohorts for length of stay (1.6 RYGB vs 1.6 RYLL days, p=0.6). After RYLL, there were higher 30-day rates of reoperation (3.3 vs 1.9%, p=0.03) and deep surgical site infections (1.3 vs 0.5%, p=0.03) compared to RYGB. There were no differences between cohorts for overall serious complications (5.1 RYLL vs 5.0% RYGB, p=1.0) and mortality (0.2 RYLL vs 0.1% RYGB, p=0.5).

Conclusions

When compared to primary RYGB, Roux-en-Y limb lengthening has a favorable safety profile with similar 30-day rates of serious complication and mortality.