Bariatric surgery is perhaps the most effective means of combatting obesity, and according to the Journal of the American College of Surgery, some form of that surgery was chosen by over 120,000 people in 2008. There is, however, more than one type of bariatric surgery, and until recently it wasn t clear which would be better in terms of post-operative complications, the rate of re-hospitalization, or the efficacy of different procedures.
Recently, however, Dr. David Arterburn from the Group Health Research Institute in Seattle, Washington, and colleagues compared the effectiveness of two types of bariatric surgery laparoscopic adjustable gastric banding vs laparoscopic gastric bypass. In the first type, an inflatable band is placed around the stomach and tightened to restrict the size of the stomach pouch. This severely reduces stomach size and the amount of food that can be consumed. In the second type of surgery, much of the stomach and small intestine are bypassed, so that nutrient and calorie absorption are minimized.
Using data from a network of 10 sites in the United States, the researchers examined the outcomes of both types of bariatric surgery. Their study included nearly 7500 individuals who had had one or the other type of surgery between 2005 and 2009.
Their main results were:
Maximum change in BMI 8.0 BMI units for gastric band patients, vs 14.8 units for bypass patients.
30-day post-surgery adverse events the risk was 0.46 for banding compared to bypass.
Subsequent intervention and hospitalizations the risk was 3.3 for banding compared to bypass for interventions, and 0.73 for hospitalizations.
The investigators concluded that the bypass surgery, although having a greater risk of short-term complications and long-term hospitalizations, also resulted in much greater weight loss as well as a lower risk of subsequent interventions.
In another recent study, the issue of whether bypass surgery is safe for diabetic patients was investigated. Dr. Ali Aminian from the Cleveland Clinic in Cleveland, OH and colleagues examined data from 16,500 patients who had undergone bypass surgery for obesity between 2007 and 2012. They found that such patients had a complication rate of 3.4 percent similar to that seen in patients who underwent gall bladder or uterus removal surgery. Further, the mortality rate of bypass surgery was very low 0.3 percent, which was comparable to that seen in patients who had knee surgery. They concluded that [E]arlier intervention with metabolic surgery to treat diabetes may eliminate the need for some later higher-risk procedures to treat diabetes complications.
ACSH s Dr. Ruth Kava agrees Since obesity is a major risk factor for type 2 diabetes, as well as for numerous other conditions, and extreme obesity responds well to bariatric surgery, the results of these studies should be explained to such individuals. In some cases, weight loss has resulted in remission of diabetes, and thus a decreased risk of some of the negative impact of the disease.
