Obesity surgery safe, effective in young and old

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A questionnaire sent to the youngest and the oldest patients in the Mayo Clinic database who had undergone obesity surgery, primarily gastric bypass, revealed that the procedure appears to be safe and effective for most patients in these two age groups. Overall, the patients had very positive reports about the procedure years after the surgery.

The Rochester, Minnesota, team undertook their research after a study of Medicare patients indicated that only 5 percent of patients benefit from gastric bypass surgery. “That’s just not our experience,” said Dr. Michael Sarr during a presentation here at Digestive Disease Week 2006.

The researchers sent the questionnaires to 155 patients age 60 years of age or older and 12 patients younger than 18 years old. They received responses from 127 of the older group and from all 12 in the younger group.

The reason for surgery in both age groups was serious obesity-related conditions. These included diabetes, High Blood Pressure and arthritis in the older patients, and diabetes, obesity-induced asthma and sleep breathing disorders in younger patients.

The prevention of poor psychosocial development in the teens was an important reason for surgery, Dr. Sarr added. “These patients aren’t nuts! They have a metabolic disorder that we don’t understand.”

The average follow-up period in the older group was five years. There was one death and 14 percent had a delay in hospital discharge due to serious complications. The five-year death rate was 6 percent. The average body mass index (BMI) dropped from 46 to 33. (BMI is a height to weight ratio commonly used to determine obesity; the normal range is between 18.5 and 24.9 - people with a BMI of 30 or higher are considered obese.) Weight-related illness resolved in 51 percent and 89 percent of patients reported satisfaction with the procedure.

The average follow-up period in the teenagers was three years. There were no deaths or serious complications as a result of surgery. BMI dropped from an average of 55 to 36. Weight-related disorders resolved in 82 percent, and 83 percent of the young people reported satisfaction.

In contrast to the Medicare data, Sarr emphasized, “in our experience (gastric bypass) surgery is quite safe.” He added that “the data are just maturing now.” The details of the optimal procedure still need to be refined. The long-term benefits versus risks and success in preventing psychosocial problems are still undetermined. “We have no good data on that.”

In his comments Sarr acknowledged that there has been some gradual weight gain in the patients at follow-up. “But 10 to 15 years out, there is a positive benefit in 65 percent.”

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