Weight loss saves lives and reduces the likelihood of numerous co-morbidities. Alas, the effects rarely last. Without Surgical Intervention, it is said that “only 2% of severely obese teenagers can lose weight and keep it off.” So a case can be made that for many morbidly obese young people, Bariatric Surgery is their only hope. The New England Journal of Medicine published an editorial by Elias S. Siraj, M.D., and Kevin Jon Williams, M.D. that recognized these unfortunate facts and added:

Bariatric Surgery results in the most weight loss and the highest rates of remission of type 2 diabetes, but the potential side effects are of concern. Furthermore, performing bariatric surgery in approximately 400 million obese persons worldwide is not feasible.

Absolutely correct. 400 million people are not about to hop onto operating tables any time soon. But how does it work out for the very small fraction who can afford it, and who are near an appropriate medical facility, and are physically and psychologically qualified? The National Institutes of Health set the recommended criterion for surgical intervention as a BMI of at least 40, or at least 35 if there are significant comorbidities present that are related to the obesity. In 2006, there were complications in 7.6% of cases. As recently as 2012, the New York Times said that studies had placed the death rate for open (not laparoscopic) surgeries, as high as 2% within 30 days. A more recent source says,

Along with the increased volume of surgical procedures, a dramatic decrease in mortality and complications related to surgical intervention has been achieved, as demonstrated in a recent meta-analysis showing a mortality rate of 0.08% within 30 days and 0.31% after 30 days.

As surgeons gained experience and the proportion of laparoscopic surgeries increased, risk declined across the board, and the number of complications decreased. But the Times suggested it was also because bariatric surgery became less of a last-resort rescue mission, and more of an elective option for patients who were thinner and healthier to begin with.

The varieties

The type of surgery makes a difference. Laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy are both restrictive procedures in that they leave less available stomach, in the first instance by blocking part of it off, and in the other, by removing part of it. Biliopancreatic diversion is a malabsorptive procedure that skips much of the small intestine, and the Roux-en-Y gastric bypass (abbreviated as RNYGBP) is a combination of both restrictive and malabsorptive types.

As in many areas of life, sometimes a do-over is necessary. The conditions that might indicate the need for a revisional procedure include the inability to tolerate solid food; nausea and vomiting,; strictures; nonhealing ulcers; and severe dumping syndrome. The revisional procedures come under the headings of conversion, correction, or reversal. With them, the mortality goes up to 1.65%. The need for a reversal is counted as a treatment failure. In addition, some of these surgical interventions are designed from the start to occur in stages, which guarantees the need for additional surgery.

Also deemed a treatment failure is a 6-year post-op patient’s BMI of 35 or higher. Sadly, in an increasing number of cases, inadequate weight loss is deemed to be sufficient reason for revisional surgery. How is it that lifestyle changes can’t pick up the slack? Could primary procedures be successful more often if the patients adopted the W8Loss2Go program? With that kind of help, could some patients be spared the need for revisional procedures?

Your responses and feedback are welcome!

Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
Source: “Another Agent for Obesity — Will This Time Be Different?,” NEJM.org, 07/02/15
Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Source: “Gastrointestinal Complications After Bariatric Surgery,” gastroenterologyandhepatology.net, August 2015
Source: “Bypass Beats Band for Weight Loss,” WSJ.com, 01/17/12

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