Durability Of Bariatric Surgery

For most patients with severe obesity, the decision to undergo bariatric surgery is one of the most important decisions they will make in their lifetime.

But once they have decided to go down this route, several important issues need to be considered, not least the choice of operation.

Apart from the surgical risk (complications at the time of surgery), patients are of course interested in how much weight they will lose. Many patients also consider the long-term outcomes (will the weight stay off?).

Interestingly, however, few patients appear well aware that if the surgery does not work, their only option may be to have another operation performed (often another type of surgery).

As of course very few patients want to have more than one operation, the question of whether or not a given operation is indeed a “definitive” procedure, that will last them a lifetime, is of considerable significance.

And this is where there are indeed important differences between the various types of bariatric surgery.

For e.g., in a paper from our group just published in OBESITY SURGERY, we review the literature on the laparoscopic sleeve gastrectomy (LSG) and note, based on a systematic review of 15 studies (940 patients), that despite sustained weight loss up to 3 years, it is presently not clear if weight loss following LSG is sustainable in the long term. We conclude that it is, therefore, not possible to determine what percent of patients may require further revisional surgery following LSG (e.g. conversion to gastric bypass).

Similarly, a paper just published in the same issue of OBESITY SURGERY by Monika Lanthaler and colleagues from Innsbruck, Austria, suggests that a significant proportion of patients undergoing laparoscopic adjustable gastric banding (LABG) may need reoperation.

In their experience with 276 patients, who underwent LABG a minimum of 9 years ago, despite good initial weight loss, 146 (52.9%) patients had at least one complication requiring reoperation.

Presently, only 148 (53.6%) patients still have their original band, 49 (17.8%) had their original band replaced with a new one, and 79 (28.6%) had their band removed. A Roux-en-Y gastric bypass was eventually done in 39 patients, and 6 patients underwent sleeve gastrectomy.

What makes this study important is the fact that the investigators managed to collect outcomes on 80% of their study population. Most surgical centres lose track of their patients and frankly have no idea what proportion of patients they operate on experience weight regain, have long-term complications, and/or end up having revisional operations.

I wonder how many patients would opt for a procedure, which although safe and relatively simple, is also associated with a 1 in 3 chance of requiring a reoperation?

Health professionals likely need to tell their patients that certain procedures may be less “definitive” than others – something that certainly must be considered in the overall risk (and cost) of any given procedure.

Duchesnay, Quebec

You can now also follow me and post your comments on Facebook

Shi X, Karmali S, Sharma AM, & Birch DW (2010). A review of laparoscopic sleeve gastrectomy for morbid obesity. Obesity surgery, 20 (8), 1171-7 PMID: 20379795

Lanthaler M, Aigner F, Kinzl J, Sieb M, Cakar-Beck F, & Nehoda H (2010). Long-term results and complications following adjustable gastric banding. Obesity surgery, 20 (8), 1078-85 PMID: 20496124