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Diabetes, Cardio-Metabolic Newsletter
Bariatric Surgery Review
3/24/14
Three commonly performed bariatric surgery procedures led to substantial and durable weight loss with a low mortality risk,
concluded the authors of an expansive review and meta-analysis of both randomized clinical trials (RCTs) and observational
studies.Five years after surgery the 161,756 patients included in the analysis maintained 26% to 37% of the loss from
baseline body mass index (BMI). Results from 37 randomized clinical trials (RCTs) showed a 30-day mortality of 0.08% and
mortality beyond 30 days of 0.31%.Complications remained fairly common (17% overall), and the reoperation rate was
7%.Consistent with previous studies, gastric bypass resulted in the greatest weight loss, and adjustable gastric banding was
associated with the lowest complication rate. The newer sleeve gastrectomy procedure seemed to offer the best combination
of weight loss and safety, as reported online in JAMA Surgery.Chang and colleagues performed a systematic review and
meta-analysis aimed at quantifying risks and benefits of specific bariatric procedures in adults. They defined risks as
perioperative and postoperative mortality, complications, and reoperation rates. Benefits comprised weight loss and remission
of obesity-related diseases.The review encompassed studies reported from Jan. 1, 2003, to March 31, 2012.The 164 articles
included in the final analysis consisted of 62 publications from 2003 to 2007 and 102 from 2008 to 2012. A third of the
studies (54) were conducted in North America, 72 in Europe, 13 in Asia, and 25 in other regions. A majority of the studies
(92) had follow-up of at least 2 years.The patients had a mean age of 44.6, preoperative mean BMI of 45.62, and preoperative
mean weight of 274 pounds. Almost 80% were women.Obesity-associated comorbidities included type 2 diabetes in 26%,
hypertension in 47%, dyslipidemia in 27%, sleep apnea in 25%, and cardiovascular disease in 7%.Observational studies
reported higher mortality as compared with the RCTs (0.22% at 30 days, 0.35% >30 days). Also in the observational studies,
adjustable gastric banding was associated with the lowest perioperative and postoperative mortality (0.07% and 0.21%),
followed by sleeve gastrectomy (0.29% and 0.34%), and gastric bypass (0.38% and 0.72%).Meta-analyses of complications
comprised data from 64 studies. Complication rates were 17% in 16 RCTs and 10% in 48 observational studies. Similar rates
were associated with each of the three surgical procedures evaluated.Re-operation rates were similar in RCTs and
observational studies (7% and 6%). The re-operation rate was lowest for gastric bypass (3%) in RCTs, whereas sleeve
gastrectomy was associated with the lowest re-operation rate in observational studies (3%). Adjustable gastric banding had
the highest re-operation rate in RCTs (12%) and observational studies (7%).Change in BMI at 1 year was reported by 69
studies, and 11 studies had 5-year BMI data. BMI loss within 5 years of surgery ranged from 12 to 17 across observational
studies. Two reports from the long-running Swedish Obese Subjects Study showed BMI loss of 6.5 at 10 years and 7.1 at 15
years.The analysis of comorbidity outcomes comprised data from 53 studies. Remission of type 2 diabetes occurred in 92%
of patients in RCTs and 86% of patients in observational studies. Hypertension remission rates were 75% in RCTs and 74%
in observational studies.The analysis of dyslipidemia remission included five RCTs, 20 observational studies, and almost
1,800 patients. Remission rates were 76% in the RCTs and 68% in the observational studies.Sleep apnea remission was
reported in five RCTs and 27 observational studies involving a total of 9,900 patients. The apnea remission rate was 96% for
the RCTs and 90% for the observational studies. Of 27 patients with cardiovascular disease 58% met criteria for
remission.The analysis shows that "bariatric surgery, overall, appears to be a very effective treatment for severe obesity, and
it is a safe treatment in terms of mortality rate and complication rate," Prachand told MedPage Today."The fact of the matter
is, there are several different operations that are being performed and there are differences in outcomes, differences in
complications that need to be taken into account when recommending any particular procedure for any individual patient.
MY COMMENTARY: Were blessed to have Dr. Ing in MLHS for these procedures. In right patient, these are
Valuable,safe. BUT we don’t sell op as ‘CURES’ for DM, as diabetes can recur if patient gains weight, or even, just as
ages.
Keep an eye out for ENDOSCOPIC sleeve procedures- no op required- not yet covered by insurance. Ask Dr. Ing
2/24/2014