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Risk of acute pancreatitis higher after vertical sleeve gastrectomy vs gastric bypass surgery

18 Oct 2018

The types of bariatric surgery differentially affect the risk of developing acute pancreatitis postoperatively, such that the risk is greater in patients who undergo vertical sleeve gastrectomy (VSG) vs Roux-en-Y gastric bypass surgery (RYGB), according to a study. Risk factors include younger age and presence of gallstones.

Researchers examined the medical records of morbidly obese patients who underwent VSG (n=205,251), RYGB (n=169,973) or hernia repair (HR control; n=16,845). They compared the rates of acute pancreatitis within 6 months postsurgery vs 6 months presurgery among the three patient groups, as well as explored risk factors and outcomes of AP after bariatric surgery.

The rates of acute pancreatitis increased significantly after vs before surgery in the VSG (0.21 percent vs 0.04 percent; adjusted odds ratio [aOR], 5.16; p<0.05) and RYGB groups (0.17 percent vs 0.07 percent; aOR, 2.26; p<0.05) but not in the HR control.

VSG was associated with a markedly greater increase in the risk of postoperative acute pancreatitis compared with RYGB (aOR, 2.28; 95 percent CI, 1.10–4.73). Moreover, relative to HR control, the risk increase was seen only with VSG (aOR, 7.58; 2.09–27.58).

Significant risk factors for developing acute pancreatitis within 6 months following bariatric surgery were younger age (18–29 years; VSG: aOR, 3.76; RYGB: aOR, 6.40; p<0.05) and gallstones (VSG: aOR, 85.1; RYGB: aOR, 46.0; p<0.05).

Acute pancreatitis presentation was usually mild, and none of the patients developed severe disease following bariatric surgery. Furthermore, researchers noted that bile ducts should be technically easier to decompress after VSG vs RYGB.

The present data highlight the need to strictly follow current bariatric surgery guidelines of postoperative ursodiol utilization, as well as early ultrasonographic screening for gallstones, especially in women and patients aged <50 years when undergoing VSG, researchers said. More prospective studies are warranted to validate the findings and identify prevention strategies to decrease the risk of acute pancreatitis.

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