Bariatric Surgery Archives

Surgical Spotlight: Gastric Bypass

Jordan on October 4, 2024

Bariatric surgery is growing, but gastric bypass procedures remain stable

Bariatric surgery is growing in volume year-over-year, but the volume of Roux-en-Y gastric bypasses, or ‘gastric bypass’ for short, has remained relatively stable over the past few years. In total, gastric bypass procedures account for approximately 20% of all bariatric procedures. Sleeve gastrectomies make up the majority of that difference and are the most common. Even though sleeve gastrectomies are simpler to perform and more straightforward surgery, significant variability still exists.

A gastric bypass procedure, on the other hand, modifies a patient’s digestive system to consume and absorb fewer calories. It is more complex and surgically challenging than sleeve gastrectomies, but interestingly, many of the surgical practices for Roux-en-Y gastric bypasses have high adoption.

Variability in procedure duration

As we found with sleeve gastrectomy procedures, procedure duration widely varies, and that variability is exacerbated when performed robotically vs. laparoscopically. In reviewing over 300 gastric bypass procedures across 4 health systems, the median procedure time varied from 68 minutes as the shortest, to 133 minutes as the longest. How is surgical practice adoption impacted by procedure time? Fast-forward to our findings by downloading here.

Performing the safest gastric bypass procedure

There are seven surgical practices defined in peer-reviewed literature to increase the surgical quality of a gastric bypass procedure that Theator’s Surgical Intelligence Platform automatically annotates. In this Theator Spotlight edition, two of them are thoroughly analyzed:

1. Closing the mesenteric defect
2. Intraoperative leak test

Closing the mesenteric defect

A common complication that carries significant morbidity after a gastric bypass procedure is a small bowel obstruction. In one study, closure of the mesenteric defects can reduce the incidence of small bowel obstruction by approximately 48%. While overall adoption is high, significant variability exists between health systems, with one achieving this surgical best practice less than 70% of the time.

Intraoperative leak test

Reducing the risk of anastomotic leaks is at the top of surgeons’ minds. A surgical practice to mitigate this risk is performing an intraoperative leak test on the gastrojejunal anastomosis. Three out of the four health systems analyzed performed this practice the majority of the time, yet variability exists in how this practice is performed.

Despite an overall high adoption of these two surgical practices in gastric bypass, significant variability exists across health systems. Check out the full report here.

Surgical Spotlight: Robotic vs. Laparoscopic Sleeve Gastrectomy

Theator on July 23, 2024

Robotic vs. Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy, also known as gastric sleeve surgery, is a frequently performed weight loss surgery that removes 80% of the stomach, leaving a much smaller organ that holds less food and liquid. A further advantage of this procedure is that the portion of the stomach that produces a hunger-inducing hormone is removed, leading to a decreased appetite and improved metabolism.

While this procedure was traditionally performed laparoscopically, in recent years more surgeons are performing robotic-assisted sleeve gastrectomies.

What’s the difference between laparoscopic and robotic-assisted sleeve gastrectomies? We’re glad you asked. In general, the main benefits of robotic-assisted surgery include a clearer view for surgeons, high accuracy of movement, and reduced trauma, meaning less tissue damage, bleeding, and pain.

Does this mean that robotic-assisted sleeve gastrectomy is the better choice? Not necessarily. Read on to find out what we learned from analyzing 505 surgical videos across a health system.

Longer Operative Times

While many aspects of surgical care affect patient outcomes, longer operative times have been associated with increased chances of complications. In the case of sleeve gastrectomy, you likely won’t be surprised to learn which approach is associated with longer operative times (*cough* robotic *cough*). But it may surprise you which procedure step is the biggest contributor to that increase in median operative time.

Download our Spotlight report to learn more.

This is just one of many data points that Theator’s Surgical Intelligence Platform automatically recognizes, analyzes, and delivers back to to health systems in digestible formats so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know more about the differences in operative time between the two approaches? We have the answer. Download the full report here.

Surgical Spotlight: Sleeve Gastrectomy

Theator on April 2, 2024

Sleeve Gastrectomy Insights

Obesity is a public health crisis in the US, affecting more than one third of adults. In addition to diet and exercise, medications and surgical procedures are effective obesity treatments for eligible patients, and laparoscopic vertical sleeve gastrectomy is the most commonly performed weight loss surgery in the world.

Theator’s Surgical Intelligence database has compiled more than 700 sleeve gastrectomy procedures to date from 10 different health systems.

Like all surgical procedures, sleeve gastrectomy has potential complications, including:

Bleeding (1.16 – 4.94 %)
Leakage (1 – 4%)
Acute pancreatitis (1.04%)
Venous thromboembolism (0.06 – 2.20%)

30-day readmission occurs in 3.89% of patients following sleeve gastrectomy. The most common reasons for readmission after bariatric surgery include:

Nausea/vomiting (14.05%)
Abdominal pain (12.14%)
Dehydration (10.78%)

Importantly, international best practice guidelines for sleeve gastrectomy note that a lack of standardization can lead to poor outcomes, and if surgeons consistently followed surgical practice techniques, surgical outcomes would be better.

For more sleeve gastrectomy insights, download our procedure spotlight report.

Surgical Practices in Sleeve Gastrectomy

Guidance on surgical practices for sleeve gastrectomy continues to evolve as the body of research on this topic grows. This is excellent news for patients, as the more practices are standardized based on clinical evidence, the better outcomes will be.

For example, staple line reinforcement may reduce the risk of bleeding along the suture line and other perioperative complications. Notably, there is no current evidence to support one staple line reinforcement technique over another, so techniques vary by surgeon and across institutions.

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know what other insights we’ve seen in our database of gastric sleeve surgeries? Download the full report here.