Abstract

Background: No robust data are available on the safety of primary bariatric and metabolic surgery (BMS) alone compared to primary BMS combined with other procedures.

Objectives: The objective of this study is to collect the 30-day mortality and morbidity of primary BMS combined with cholecystectomy, ventral hernia repair, or hiatal hernia repair.

Setting: This is an international, multicenter, prospective, and observational audit of patients undergoing primary BMS combined with one or more additional procedures.

Methods: The audit took place from January 1 to June 30, 2022. A descriptive analysis was conducted. A propensity score-matching analysis compared BLEND study patients with those from the GENEVA cohort to provide an objective evaluation of combined procedures versus primary BMS alone.

Results: A total of 75 centers submitted data on 1036 patients. Sleeve gastrectomy was the most common primary BMS (N = 653, 63%), and hiatal hernia repair was the most common concomitant procedure (N = 447, 43.1%). RYGB accounted for the highest percentage (20.6%) of a 30-day morbidity, followed by SG (10.5%). More than one combined procedure had the highest morbidities among all combinations (17.1%). Of the 134 complications, 129 (96.2%) were Clavien-Dindo I–III, and 4 were CD V. Patients who underwent primary bariatric surgery combined with another procedure had a pronounced increase in the 30-day complication rate compared with those who underwent only BMS (12.7% vs. 7.1%).

Conclusion: Combining BMS with another procedure increases the risk of complications, but most are minor and require no further treatment. Combined procedures with primary BMS are a viable option for selected patients following multidisciplinary discussion. Graphical Abstract

Keywords: metabolic surgery, Bariatric Surgery, BLEND study,