Daniele Tassinari

Objective To assess safety and healthcare utilization (HU) after metabolic/bariatric surgery (MBS) and compare it to commonly performed general surgery procedures for benign indications. Research Design and Methods Data obtained from a nationwide database (NHS Digital) on 800 consecutive patients who underwent bariatric surgery (n = 100) and seven other types of surgery (n = 100 for each) for non-acute, non-cancer indications at a tertiary hospital in England. Non-MBS procedures included adrenalectomy, gastro-esophageal junction surgery (GEJ), in-patient cholecystectomy (IC), outpatient cholecystectomy (OC), colorectal surgery (CR), hernia surgery (HS) and neck endocrine surgery (NES). Results Despite a higher number of preoperative co-morbidities and ASA score, MBS had significantly lower odds of 30-day major complications (Clavien–Dindo grade≥IIIa) compared to CR (6%;p = 0.013) and GEJ (8%;p = 0.004). No differences in complication rates with all other groups. The total number of procedure-related readmissions over 5-year after MBS were similar to HS, NES or IC and lower than CR, AS, and GEJ. The average per-patient 5-year cost of procedure-related readmissions after MBS was £790 + 337, lower than for CR (£8,270 + 3218, p < 0.001), AS (£3242 + 772, p < 0.001) and GEJ (£1705 + 976, p = 0.013) and similar to other procedures. There was a higher number of outpatient visits after MBS in the first two years after surgery, consistent with national protocols and no differences in 5-year A&E attendance among groups. Conclusions MBS is associated with a relatively low risk of post-operative complications and 5-year healthcare use compared to other commonly used types of surgical treatments. These findings could help dispel misperceptions that undermine access to effective treatment of obesity.

Remnant dimension is considered one of the crucial elements determining the success of sleeve gastrectomy (SG), and dilation of the gastric fundus is often believed to be the main cause of failure.