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Metabolic and Bariatric Surgery

Created on::
2010-03-24 13:11:03
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OVERVIEW

-Treatment for morbid obesity and obesity-related diseases and conditions; limits amount of food stomach can hold, and/or limits amount of calories absorbed, by surgically reducing the stomach’s capacity to a few ounces
-Candidates have body mass index (BMI) of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea
-About 220,000 people with morbid obesity in the U.S. had bariatric surgery in 2008
-About 15 million people in the U.S. have morbid obesity; 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery
-Bariatric surgery costs an average of $17,000 - $26,000; insurance coverage varies by provider.

IMPACT ON OBESITY-RELATED DISEASES

-Can improve or resolve more than 30 obesity-related conditions, including Type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol
o Gastric bypass resolves Type 2 diabetes in nearly 87% of patients1
o Band surgery resolves Type 2 diabetes in 73% of patients2
o Cuts risk of developing coronary heart disease in half3
o Resolves obstructive sleep apnea in more than 85% of patients4

BARIATRIC SURGERY: RISKS VS. BENEFITS

-In 2007, federal government (Agency for Healthcare Research and Quality) and clinical studies report significant improvements in safety5
o Risk of death from bariatric surgery is about 0.1%
-Bariatric surgery increases lifespan, as compared to those who do not have surgery
o Patients may improve life expectancy by 89%6
o Patients may reduce their risk of premature death by 30 to 40%7,8
-Dramatic reduction in risk of death from obesity-related diseases, as compared to those who do not have surgery
o Risk of death from diabetes down 92%, from cancer down 60% and from coronary artery disease down 56%8

 

LONG-TERM EFFECTIVENESS OF BARIATRIC SURGERY

-Typically patients have maximum weight loss within 1-2 years after surgery and maintain a substantial weight loss, with improvements in obesity-related conditions, for years afterwards
-Patients may lose 30 to 50% of their excess weight 6 months after surgery and 77% of their excess weight as early as 12 months after surgery9
-Long-term studies show up to 10-14 years after surgery, morbidly obese patients who had surgery maintained a much greater weight loss and more favorable levels of diabetes, cholesterol and hypertension, as compared to those who did not have surgery.

ADOLESCENTS AND BARIATRIC SURGERY

-As obesity rates rise in the U.S., increasing number of adolescents (12-17 years old) are having bariatric surgery; an estimated 349 in 20045
-Research shows that bariatric surgery may be an effective treatment for Type 2 diabetes, high blood pressure and high cholesterol in extremely obese adolescents12
-Long-term efficacy and impact is subject of ongoing research

MOST COMMON TYPES OF BARIATRIC SURGERY

Gastric Bypass

-Stomach reduced from size of football to size of golf ball
-Smaller stomach is attached to middle of small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories
-Patients eat less because stomach is smaller and absorb fewer calories because food does not travel through duodenum Laparoscopic Adjustable Gastric Banding (LAGB)
-Silicone band filled with saline is wrapped around upper part of stomach to create small pouch and cause restriction.
-Patients eat less because they feel full quickly
-Size of restriction can be adjusted after surgery by adding or removing saline from band Bilio-Pancreatic Diversion with Duodenal Switch
-Similar to gastric bypass, but surgeon creates sleeve-shaped stomach
-Smaller stomach is attached to final section of small intestine, bypassing the duodenum
-Patients eat less because the stomach is smaller and absorb fewer calories because food does not travel through the duodenum.

 

NEWER PROCEDURES & SURGICAL DEVICES

-Vertical Sleeve Gastrectomy
o Stomach restricted by stapling and dividing it vertically, removing more than 85%
o Procedure generates weight loss by restricting the amount of food that can be eaten
o Currently indicated as an alternative to gastric banding
-Natural Orifice Translumenal Endoscopic Surgery (NOTES)
o Emerging minimally invasive procedure still in clinical trials
o Surgery performed through natural orifice such as mouth or vagina, eliminating need for
external incisions
o Patients may experience a quicker, less painful recovery

 

 

American Society for Metabolic & Bariatric Surgery

 http://www.asmbs.org/

1Buchwald, H. et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. American Journal of Medicine. 2009;
122(3): 205-206.
2 Dixon, JB et al. Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes. Journal of the American Medical Association. 2008; 299(3):
316-323.
3 Torquati, Alfonso, MD, MSCI, FACS, Wright, Kelly, MD, FACS, Melvin, Willie, MD, FACS, and Williams, Richard, MD, FACS. “Effect of Gastric
Bypass Operation on Framingham and Actual Risk of Cardiovascular Events in Class II to III Obesity.” Journal of the American College of Surgeons. Vol
204, No. 5, May 2007.
4 Rasheid, Sowsan et al. Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity. Obes Surg
2003; 13, 58-61.
5Agency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. January 2007.
6 Christou, NV et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery. 2004;240:
416–424.
7 Sjöström, Lars. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. New England Journal of Medicine. 2007; 357:741-52.
8 Adams TD. Long-Term Mortality after Gastric Bypass Surgery. N Engl J Med 2007; 357:753-61.
9 Wittgrove, AC, et al. Laparoscopic Gastric Bypass, Roux-en-Y: Technique and Results in 75 Patients With 3-30 Months Follow-up. Obesity Surgery 1996:
6, 500-504.
10 Pories, WJ et al. Who Would Have Thought It: An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Annals of
Surgery. 1995:222(3):339-352.
11 Sjöström, L et al. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. New England Journal of Medicine. 2004; 351:
2683-2693.
12 Inge, TH. Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents. Pediatrics
2009; 123(1):214-222.