WEDNESDAY, July 29-For those who are considering bariatric surgery to combat significant obesity, a new study suggests that the risk of complications may be much lower than what has already been reported.
The study, which examined both gastric bypass surgery and laparoscopically adjustable gastric banding (lap band surgery), found that the risk of death for these interventions was 0.3% and the risk of a major negative result was 4.3 percent.
“Bariatric surgery is safe,” says study co-author Dr. Bruce Wolfe, professor of surgery at Oregon Health & Science University in Portland. “Certain factors [such as a history of blood clots, obstructive sleep apnea or impaired functional status] increase the risk of complications, but you can discuss these risks as well as the potential benefits with your surgeon. “
The results of the study appear in the July 30 issue of the New England Journal of Medicine.
As obesity rates have increased, so is the popularity of bariatric surgery. Although it is a major surgical procedure, the benefits for severely obese people, in general, outweigh the risks. In fact, the risk of death over time is about 35 percent less for someone who has had surgery compared to someone who remains extremely obese, according to background information in the study.
However, surgery is not for everyone. “If you’re five or 10 pounds overweight, bariatric surgery is not for you,” said Dr. Malcolm K. Robinson, an assistant professor of surgery at Harvard Medical School, and the author of an accompanying editorial in the same issue of the journal.
“Basically, when I or my colleagues advise surgery, it’s because the benefits of surgery outweigh the risks. In general, this is the case for a person with a BMI [body-mass index] of 35 and the weight of related health problems such as diabetes or high blood pressure, or a person with a BMI of 40 or more, “said Robinson, who added that the risks of surgery keep her down, those of the BMI numbers may decrease even more in the future.
The present study included 4,776 people who underwent one of the following types of bariatric surgery: lap band surgery (1,198 patients), gastric bypass laparoscopy (2,975 patients), open gastric bypass (437 patients) or another process (166). All operations were performed by specially qualified surgeons for this study. All operations took place between March 2005 and December 2007.
The average age of the study participants was 44.5 years, 22% of the study volunteers were male and 11 percent were nonwhite. The mean BMI of the study was 46.5. More than half of the study group had at least two concomitant conditions, the study authors noted.
In his editorial, Robinson points out that these procedures may represent “scenarios” because they have been performed by experienced surgeons at high volumes of bariatric surgery centers. However, he said that because the field of bariatric surgery has grown so much in recent years, he believes that these results are the usually achievable phenomenon. “
Both Robinson and Wolfe recommend that anyone considering bariatric surgery should choose an institution that has been designated as a “Center of Excellence” because it means that the surgeon and the entire healthcare team are qualified and experienced.