Comparative safety profile of metabolic and bariatric surgery procedures: an analysis spanning twelve years
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 28 August 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Alain Elian, David Richter, Mussa Ibrahim, Rami Madani, Desmond Zeng, Saad Shebrain
- PMID
- 42760184
- DOI
- 10.1016/j.soard.2026.08.018
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 20 September 2026): Comparative safety of LSG, LRYGB, LBPD/DS procedures
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LRYGB) are the most commonly performed metabolic and bariatric surgery (MBS) procedures, while laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) remains a less common alternative. We used pairwise propensity score matching (PSM) to compare the short-term outcomes of the 3 procedures. OBJECTIVES: This study aimed to compare early postoperative outcomes among patients undergoing LSG, LRYGB, and LBPD/DS. Primary outcomes included 30-day all-cause mortality, serious morbidity, and overall morbidity. Secondary outcomes included readmission, unplanned reoperation, length of hospital stay, and operative time. SETTING: A national, multicenter study of patients who underwent MBS at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). METHODS: Cases of LSG, LRYGB, and LBPD/DS performed between 2005 and 2017 were identified from the ACS-NSQIP database. Pairwise PSM and logistic regression analysis were performed to compare postoperative outcomes within 30 days of surgery. RESULTS: Of the 188,012 patients identified, 6324 were matched (2108 in each group). Compared to LRYGB, LSG was associated with lower odds of serious morbidity (odds ratio [OR] .61, P = .016), reoperation (OR .31, P < .001), and readmission (OR .39, P < .001). In contrast, LBPD/DS was associated with higher odds of serious morbidity (OR 1.76, P < .001), minor morbidity (OR 1.65, P < .001), and readmission (OR 1.37, P = .039). CONCLUSIONS: Despite adjusting for baseline characteristics, LBPD/DS remained associated with the highest odds of 30-day complications, whereas LSG demonstrated the most favorable safety profile. Careful patient selection and thorough preoperative optimization are essential for achieving optimal outcomes in patients undergoing MBS.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.