Assessment of the impact of technical modifications on morbidity and mortality in bariatric surgery: analysis of 12 years of experience at an accredited center

Abstract

Background: Bariatric surgery is the most effective and sustainable treatment for severe obesity.
Objective: The aim of this study is to describe the morbidity and mortality associated with bariatric surgery at a specialized center and to evaluate the impact of technical modifications implemented during the study period.
Materials and methods: We conducted an observational, analytical, and retrospective study that included all patients > 18 years who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2012 and 2024. Morbidity and mortality rates were analyzed, along with the percentage of reinterventions and outcomes after modifying the techniques.
Results: A total of 663 procedures were performed: 560 (84.4%) were RYGB and 103 (15.6%) were SG procedures. Most patients were female (n = 482; 72.7%), and mean body mass index (BMI) was 46.3 ± 8.2 kg/m². Major complications occurred in 38 (5.3%) patients, and 3 patients (0.4%) died.
Early complications were observed in 24 patients (63.2%), with upper gastrointestinal bleeding (n = 10; 1.5%) being the most common. Obstructions due to internal hernias were the most common late complications (n = 10; 1.5%). There were no new events following the implementation of systematic closure of the mesenteric defect, resulting in a significant risk reduction adjusted for follow-up time (HR 0.12; 95% CI: 0.03–0.50; p = 0.003). Overall morbidity and mortality decreased from 31/467 (6.6%) to 7/196 (3.5%) after the technical modifications were implemented.
Conclusion: The technical modifications implemented reduced bariatric surgery-associated morbidity and mortality. The safety profile achieved was comparable to that reported in the international literature.