New study evaluates effectiveness of weight loss surgery in individuals with obesity, diabetes
Of the patients, about half had the Roux-en-Y gastric bypass procedure and the rest a sleeve gastrectomy.
In sleeve gastrectomy, a part of the stomach is excised so that the capacity is reduced, and the patients feels full earlier during meals. This helps patients eat less and thus lose weight. In the Roux-en-Y, the stomach is replaced by a pouch created from the intestine, into which the food enters once it is swallowed. The real stomach is thus bypassed to encourage the eating of small meals.
The scientists examined the data to see what happened five years after the first surgery. The findings
The researchers found that following a gastric bypass, a significantly greater number had had a second operation or other intervention on an abdominal organ, at about 12% compared to 9% after a gastric sleeve operation. Both the rates of hospital admission and the occurrence of endoscopy were increased after the gastric bypass, though death rates remain the same in both groups.
Sleeve gastrectomy may have greater benefits over the gastric bypass in patients who are less overweight, and who have fewer coexisting illnesses.
The reasons for the increased rate of surgical intervention after the gastric bypass could be its greater complexity, according to Courcoulas, who doesn’t forget that some of these interventions are intended to improve the health such as, for instance, repairing a hernia. The researchers also point out that gastric bypass, while it seems to have slightly greater risks, also can have bigger advantages. In fact, a preceding study examining the same dataset shows that weight loss occurred to a significantly greater extent after gastric bypass than sleeve gastrectomy. Implications
The researchers hope that these findings will one day help choose the type of bariatric surgery, whether by patients or by the healthcare provider. When both take part in taking clinical decisions, according to Courcoulas, “It starts with a conversation about what their preferences and values are. Some people value low risk, some value high weight loss. It's important to have information on both sides of the risk-benefit equation.” The current study will hopefully supply some missing details on both sides so that more people can make informed health decisions. Journal reference:
Courcoulas A, Coley RY, Clark JM, et al. Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA Surg. Published online January 15, 2020. doi:10.1001/jamasurg.2019.5470, https://jamanetwork.com/journals/jamasurgery/fullarticle/2758646
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