Short-term outcomes of primary laparoscopic single-anastomosis gastric bypass versus revisional procedures: a multicenter retrospective cohort study.

Objective

To compare early postoperative outcomes between primary and revisional laparoscopic single-anastomosis gastric bypass (LSAGB) and to evaluate the association between early postoperative physiological abnormalities and life-threatening complications.

Setting

Multicenter study conducted across 4 tertiary referral bariatric centers.

Methods

In this multicenter retrospective cohort study, 5334 consecutive patients undergoing LSAGB between 2016 and 2020 were analyzed, including 4800 primary and 534 revisional procedures. Postoperative complications were classified using the Clavien-Dindo system. Multivariable logistic regression identified independent predictors of morbidity. Early postoperative physiological abnormalities were evaluated individually and cumulatively to assess their association with life-threatening complications (grade ≥ IIIa).

Results

Revisional LSAGB was associated with significantly higher overall (42.9% versus 20.2%; P < .001) and major complication rates (10.7% versus 3.7%; P < .001). In multivariable analysis, revisional surgery remained the strongest independent predictor of postoperative morbidity (adjusted OR 2.58, 95% CI 2.17-3.07; P < .001) and major complications (adjusted odds ratio [OR] 3.18, 95% confidence interval [CI] 2.32-4.36; P < .001). Operative duration (OR 1.15 per 10 min), age (OR 1.03 per year), comorbidity burden (OR 1.41), and diabetes mellitus (OR 1.29) were also independently associated with increased risk. Early postoperative abnormalities were strongly associated with life-threatening complications, with a marked non-linear increase in risk from .12% (no abnormalities) to 53.6% (≥4 abnormalities), demonstrating clear risk stratification.

Conclusions

Revisional LSAGB represents a higher-risk procedure compared with primary surgery. Early postoperative physiological abnormalities, particularly when cumulative, provide a clinically actionable framework for early detection of life-threatening complications and may support improved postoperative surveillance and timely intervention.