Abstract
PURPOSE: Metabolic bariatric surgery (MBS) is an effective treatment for severe obesity. While randomized trials have shown comparable medium-term outcomes for laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB), real-world data on perioperative safety remain limited. This study compares in-hospital mortality, complications, and length of stay between LSG and LRYGB in a large German cohort. METHODS: We performed a cross-sectional analysis of anonymized hospital data from 49 German institutions (January 2019–January 2024), including 3,389 MBS procedures (LSG: n = 2,664; LRYGB: n = 725). Outcomes included in-hospital mortality, defined perioperative complications (e.g., hemorrhage, infection, anastomotic leak), and length of hospital stay. Logistic regression adjusted for age, sex, BMI categories, and comorbidities was used to assess associations. RESULTS: Most individuals (69.1%) had a BMI ≥ 40 kg/m². LSG was more common in individuals with BMI ≥ 50 kg/m², whereas LRYGB was preferred in individuals with lower BMI and higher metabolic burden. In-hospital mortality was low: two deaths occurred after LRYGB (0.3%), none after LSG. Overall complication rates were similar (LSG: 3.9%; LRYGB: 4.1%). We did not observe statistically significant differences in complication risk; however, confidence intervals were wide, reflecting limited statistical power. Median length of hospital stay was three days for both groups; prolonged stays (> 7 days) occurred in 3.5% (LSG) vs. 3.6% (LRYGB; p = 0.863). CONCLUSION: Both procedures demonstrated low complication and mortality rates in routine clinical practice.