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Sánchez et al. Mini-invasive Surg 2024;8:36 https://dx.doi.org/10.20517/2574-1225.2024.72 Page 7 of 9

It was interesting to see that revisional surgery in LATAM doubled the Mexican figure.

Finally, the analysis of outcomes is the most important. Data from registries in other countries have served
to develop composite measures of quality and improve safety culture in hospitals, improve patient care and
[15]
reduce mortality . An example is the Michigan Bariatric Surgery Collaborative, which developed
innovative outcome reports in MBS that led to the establishment of accreditation standards for bariatric
centers. Today, their procedures are considered global benchmarks of surgical quality [16,17] . In terms of
surgical morbidity, leaks were twice as frequent in Mexico than in LATAM. In a multi-institutional analysis
[18]
of 40,983 patients who underwent RYGB published in 2018 , the leak rate was 1.2%. Preoperative history
of oxygen dependency, hypoalbuminemia, sleep apnea, hypertension, and diabetes mellitus were factors
predictive of gastrointestinal leak. Additionally, the use of intraoperative provocative testing and placement
of a surgical drain were associated with a higher leak rate. In the absence of information on patient
characteristics, it is difficult to make an appropriate judgment of our increased leak rate. Surgeons from the
participating institutions have been notified of the results and will review their institutional results.

Despite differences in the selection of surgical procedures, weight loss and resolution of comorbid
conditions were very similar in both series. In order to further assess potential differences in the resolution
of comorbid conditions between SG and RYGB, the total series was analyzed as a group. It was noticed that
T2D, arterial hypertension, and dyslipidemia were significantly more frequent in the group of patients
undergoing bypass. This may reflect the perception among surgeons that RYGB is more efficient in the
control of these comorbid conditions. However, several studies have shown that weight loss and resolution
of comorbid conditions are very similar in patients undergoing SG and RYGB, and this may be reflected in
global trends and preferences. SG is the most frequently performed surgical procedure in both the USA and
LATAM [13,19] . Surprisingly, this trend is not observed in the data for Mexico, perhaps because of the
participating institutions.

In addition to the analysis included in our study, we think that it is highly important to obtain reliable data
from LATAM countries as quality control, for benchmarking, education, and to encourage coverage by
[15]
insurance companies .
The study has several limitations. One is the number of patients with incomplete follow-up, which is a
known problem in MBS. Another is the limited number of institutions included in each country. We realize
that in Bariatric patients, it is very important to have long-term results. However, we believe that a medium-
term analysis is very important to address potential problems that may require prompt attention.

In conclusion, our analysis supports the value of registries as a valuable tool for comparing practices and
outcomes. Relevant findings include: similar demographics between both groups, a preference for RYGB in
Mexico, similar 30- and 60-day surgical morbidity between groups, and despite differences in the selection
of surgical procedures, weight loss and resolution of comorbid conditions appear very similar in both
groups.

DECLARATIONS
Authors’ contributions
Inclusion of patients in the database and manuscript preparation: Sánchez HA
Data analysis and manuscript review: Velázquez-Fernández D
Inclusion of patients in the database and review of results: Zerrweck C, Campos F, Zapata M, Guilbert L,
Pantoja JP, Sierra M, González I, Romero G