Bariatric surgery: acute pancreatitis more common with VSG than RYGB

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Takeaway

  • Vertical sleeve gastrectomy (VSG) carries a more than 2-fold higher postoperative risk for acute pancreatitis (AP) than Roux-en-Y gastric bypass surgery (RYGB) or controls.
  • Postoperative gallstones, regardless of surgery, were associated with the greatest risk for AP.

Why this matters

  • RYGB is the preferred type of bariatric surgery if AP is a concern.
  • Both RYGB and VSG patients should be screened for postoperative gallstones.

Study design

  • Retrospective cohort of morbidly obese patients who underwent VSG (n=205,251), RYGB (n=169,973), or hernia repair (HR) controls (n=16,845) in the 2012-2014 National Readmission Database.
  • Primary outcome was rates of AP within 6 months postsurgery vs 6 months presurgery.
  • Funding: None.

Key results

  • AP rates increased post- vs pre-VSG (0.21% vs 0.04%; aOR, 5.16; P<.001 and post- vs pre-rybg aor p=".003)," but not pre-hr.>
  • VSG had more than 2-fold greater increase in AP risk than RYGB (aOR, 2.28; P=.03).
  • Postsurgery development of AP (vs presurgery) was associated with gallstones:
    • VSG: aOR, 85.1 (P<.001 and>
    • RYGB: aOR, 46 (P<.001>
  • Postsurgery development of AP (vs presurgery) was associated with younger age (18-29 years):
    • VSG: aOR, 3.76 (P=.001); and
    • RYGB: aOR, 6.40 (P=.001).

Limitations

  • Retrospective design.
  • Reliance on ICD-9-CM coding.