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Article 8 FIRST REPORT FROM THE AMERICAN COLLEGE OF SURGEONS BARIATRIC SURGERY CENTER NETWORK: LAPAROSCOPIC SLEEVE GASTRECTOMY HAS MORBIDITY AND EFFECTIVENESS POSITIONED BETWEEN THE BAND AND THE BYPASS CITATION Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–422. PURPOSE OF THE STUDY The purpose of this study is to assess and compare the short-term safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) to the laparoscopic adjustable gastric band (LAGB), the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the open Roux- en-Y gastric bypass (ORYGB) to provide information for improved patient care and coverage decisions by policy makers. METHODS Data were collected during a prospective, multi-institutional, observational study of up to 1 year comparing the LSG to established treatments for obesity by trained data reviewers. Established treatments for obesity included LAGB, LRYGB and ORYGB. Univariate and multivariate analyses compared 30-day, 6-month, and 1- year outcomes, including morbidities and mortalities, readmission rates, reoperation rates, and overall reduction in body mass index (BMI). Data were collected from the American College of Surgeons— Bariatric Surgery Center Network (ACS-BSCN) accreditation program. All cases that were entered into the ACS-BSCN data collection system, submitted by 109 hospitals on 28,616 patients from July 2007 and September 1, 2010, were considered in this analysis. RESULTS • Rate of postoperative complications for LSG is between LAGB (lower rates) and LRYGB (higher rates). • Aside from lower rates of stricture, intestinal obstruction, and anastomotic ulcer, LSG has a comparable rate of most postoperative bariatric specific occurrences requiring readmission, reoperation, or intervention. • The number of LSG cases has increased consistently, and currently comprises approximately 7.8% of primary bariatric procedures performed at accredited centers. • LSG has lower reoperation/ intervention rates compared to the bypass. • LSG has higher rates for organ space infection, renal insufficiency but lower rates in ventilator dependence compared to LRYGB • LSG has significantly lower rates of risk-adjusted reoperation/ intervention rates compared to the LRYGB. • Average reduction in BMI for LSG was less than weight loss after LRYGB/ORYGB but greater than the weight loss after LAGB. • The clinical effectiveness of the LSG in improving or resolving many obesity-related comorbidities is positioned between the band and the bypass. CONCLUSION According to the data collected from the ACS-BSCN accredited hospitals, LSG seems to be a safe and effective alternative to other established obesity treatments, such as the LAGB, LRYGB and ORYGB. Data for LSG conclude that reduction in BMI, complication rates, and reduction in obesity-related illnesses lie between LAGB (which had fewer complications but less reduction in weight) outcomes and LRYGB (which had higher complications but higher reduction in weight) outcomes. 18S Bariatric Times • June 2012 • Supplement