Background

Although numerous studies have examined small bowel obstruction (SBO) post-bariatric surgery, they are limited by single center design. There is limited broad epidemiologic data on incidence of SBO after bariatric surgery. The aim of this study was to comprehensively evaluate the cumulative incidence of SBO.

Methods

The SPARCS database was used to identify patients with previous Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) who required surgery for SBO at the time of first diagnosis. We analyzed the incidence of and prognostic indicators of surgery for SBO. Multivariable Fine-Gray models were utilized to examine the association between each risk factor and subsequent SBO surgery where death was treated as a competing risk event.

Results

A total of 38,582 RYGB patients and 91,982 SG patients were included with median follow-up time of 1,492 and 1,074 days, respectively. The cumulative incidence of surgery for SBO for RYGB was 0.46 % (0.39%-0.53%), 1% (0.89-1.12%), 1.89% (1.71-2.08%) at 1, 3 and 6 years, respectively. The cumulative incidence of surgery for SBO for SG was 0.13% (0.11%-0.16%), 0.55% (0.49%-0.61%), and 2.02% (1.87%-2.18%) at 1, 3 and 6 years, respectively.No significant difference existed in risk of SBO between RYGB and SG (p=0.72). Other prognostic factors for SBO included female gender, chronic pulmonary disease, phlebitis, black ethnicity and Medicare/Medicaid insurance.

Conclusions

Bariatric surgery patients have a low risk of needing subsequent surgery for SBO, with comparable rates between RYGB and SG, indicating minimal added risk with RYGB compared to other intra-abdominal procedures.