Revisional Roux-en-Y gastric bypass may increase bleeding risk in addition to VTE risk, finds study

A new study published in the journal of Obesity Surgery showed that after revisional Roux-en-Y gastric bypass (RYGB), the likelihood of venous thromboembolic events (VTE) is similar to that of initial procedures.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are examples of VTE. The riskiest times to develop VTE include following major surgery, right after an accident, and right after periods of inflammation and infection. This is due to the fact that vein damage from surgery or trauma can result in blood clots.

Bariatric surgery (BS) is a technically hard technique done on high-risk patients that might result in medical and surgical problems like venous thromboembolism. Venous thromboembolic events following first bariatric surgery are linked to a moderate-to-high risk. Also, the risk related to revisional surgery is less specific. Thus, this study carried out by Economopoulos and colleagues was to determine the risk of VTE after revisional Roux-en-Y gastric bypass surgery (RYGB) in comparison to traditional RYGB.

In this study, using a bariatric-specific database, adults with a BMI of at least 35 kg/m2 who had primary or revision/conversion RYGB between January 1, 2015 and December 31, 2019 were identified. Deep vein thrombosis and/or pulmonary embolus were the criteria used to define VTE. Propensity score matching with a 3:1 ratio was used to compare the two groups' 30-day VTE and transfusion rates.

• A total of 1,97,186 patients (92.4%) underwent primary RYGB, where 16,144 patients (7.6%) underwent revisional surgery. Revisional group patients had less comorbidities than main RYGB patients. In the matched cohort of 64,258 surgeries, there were 48,116 (74.9%) primary RYGB instances as opposed to 16,142 (25.1%) RYGB revisions.
• The incidence of VTE was comparable in the revisional surgery group relative to the propensity matched primary RYGB group. But, transfusion was more prevalent in the revisional group.
• The revisional group experienced greater rates of readmission, reoperation, longer lengths of stay, and operations lasting more than 180 minutes (p < 0.001) when compared to the matched primary RYGB group.

Overall, the revisional and initial RYGB have comparable VTE rates. Among other things, revisional RYGB instances carry a higher risk of haemorrhage. It is crucial to identify people who are more likely to experience difficulties.

Source:

Economopoulos, K. P., Szoka, N., Eckhouse, S. R., Chumakova-Orin, M., Kuchibhatla, M., Merchant, J., & Seymour, K. A. (2024). Venous Thromboembolic Events Following Revisional Gastric Bypass: An Analysis of the MBSAQIP Database from 2015 to 2019 Using Propensity Matching. In Obesity Surgery. Springer Science and Business Media LLC. https://doi.org/10.1007/s11695-024-07511-y