Less-invasive weight loss surgery safer: study
Minimally-invasive weight loss surgery is safer than open surgery, with patients suffering fewer complications during those procedures, according to a new study of more than 150,000 people who had a gastric bypass in the United States.
Patients also left the hospital sooner - and with a slightly smaller medical bill - after so-called laparoscopic gastric bypass procedures, researchers from Stanford University in California found.
During gastric bypass, the surgeon creates a pouch out of the top portion of the stomach, then connects it to the small intestine so fewer calories are absorbed during digestion. For laparoscopic procedures, only a few small cuts in the stomach are made and a tiny camera is inserted to allow the surgeon to get a full view during the procedure, as compared to the one large cut made during open surgery.
“From a surgeon’s perspective, the ability to see (during) the surgery is enhanced doing it laparoscopically,” said Dr. Anita Courcoulas, a professor and bariatric surgeon from the University of Pittsburgh Medical Center, who wasn’t part of the new research team.
“From the patient’s perspective, there’s much less pain, so they can walk and move and return to normal activities sooner.”
The findings support past research suggesting the less-invasive procedure is safer, and are “important” because they reflect complications and deaths on a national level, according to Courcoulas.
Laparoscopic vs Open Gastric Bypass SurgeryDifferences in Patient Demographics, Safety, and Outcomes
Conclusion In this population-based study, LRYGB provided greater safety than ORYGB even after adjusting for patient-level socioeconomic and comorbidity differences.
Obesity is a major public health concern as rates of obesity have significantly increased. In the United States, prevalence of obesity in adults increased from 15% in 1980 to 32% in 2004 and 6% to 19% in children during the same period. According to Centers for Disease Control and Prevention reports, 34% of US adults older than 20 years are obese. In addition, the Centers for Disease Control and Prevention reports 66% of US adults are overweight or obese and 5 million are extremely obese. The 2008 F as in Fat report indicates that 25% of adults are obese in 28 states and that no state has had a decrease in the numbers of obese individuals.
Studies have also shown troubling sociodemographic disparities in the United States because higher proportions of African American individuals, Hispanic individuals, Medicaid patients, and those of low education and income status are obese. Obesity concerns are not limited to the United States, as obesity has become an international issue, even in less developed countries.
Obesity has been associated with numerous adverse health conditions including diabetes mellitus, cardiovascular disease, nonalcoholic liver disease, increased risk of disability, hypertension, dyslipidemia, some forms of cancers, gallstones, and musculoskeletal disorders. These adverse health conditions lead to a significant increase in early mortality and reduction in life years in obese individuals. In addition, obese individuals report lower quality of life and greater discrimination, bias, and stigma.15 - 16 Treating obesity and its complications has been estimated to cost approximately $92 billion a year.
Bariatric surgery has proven to be the most effective and enduring option in treating the morbidly obese. In the 10-year Swedish Obesity Study, gastric bypass surgery patients showed greater long-term weight loss, health-related quality-of-life improvements, and reduction in various risk factors compared with controls receiving conventional treatment. The Swedish Obesity Study trial found that the decrease in weight and risk factors was greater in those treated by gastric bypass than those treated by medical intervention, banding, or vertical banded gastroplasty.
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Gaurav Banka, MD; Gavitt Woodard, MD; Tina Hernandez-Boussard, PhD, MPH; John M. Morton, MD, MPH
Dr. John Morton and his colleagues analyzed data on weight loss procedures done at about 1,000 U.S. hospitals each year between 2005 and 2007, including 41,000 open gastric bypass surgeries and 115,000 laparoscopic surgeries.
Looking back at safety records for the procedures, the researchers found about 19 percent of patients undergoing open surgery had at least one complication - such as developing pneumonia or needing a blood transfusion - compared to just over 12 percent of those who had less-invasive surgery.
One in 500 obese patients in the open surgery group died during or shortly after the procedure, compared to one in 1,000 in the laparoscopic group.
People getting open surgery also had longer hospital stays - 3.5 days versus 2.4 days, on average, the researchers reported in the Archives of Surgery. And their procedures cost slightly more, with a price tag of $35,000 compared to just under $33,000.
The records didn’t have information on longer-term complications or on how overweight patients were going into the surgery.
WHAT SHOULD PATIENTS BE OFFERED?
Weight loss procedures are typically considered for people with a body mass index of at least 35 and other medical problems such as diabetes, or for people with a BMI of 40 without other related conditions. For a five-foot, six-inch person, that equates to 217 pounds or 248 pounds.