New study claims gastric bypass and gastric banding weight-loss surgery safe

St. Louis, MO

Obese patients who undergo weight-loss surgery have a low risk of dying or developing complications that require a second surgery or longer hospital stay, a study found.

About 4.1 percent of 4,610 people in the study who had either gastric bypass surgery or gastric banding developed at least one major complication in the 30 days after surgery, according to research published today in the New England Journal of Medicine. Those who underwent gastric banding had fewer complications.

Weight-loss surgery has soared in popularity in the U.S. The number of such operations rose more than tenfold to about 171,000 in 2005 from about 16,200 in 1994, according to an editorial in the journal. The data shows that, at least in the short term, these procedures are relatively safe and future research may help identify which surgery is best for a particular patient, said study author Bruce Wolfe, a professor of surgery at Oregon Health and Science University in Portland, in a telephone interview. Based on the findings, he said, "the surgery is basically safe."

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Gastric bypass surgery malpractice: Fatal malpractice at NY hpspital unreported

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Unreported gastric bypass malpractice at New York hospital results in patient death

Coney Island, NY

On July 17, 2006, Robert Asta had gastric bypass surgery at Coney Island Hospital. Six days later, the 54-year-old cook was dead.

Internal hospital records reveal a "foreign object" was left inside his body postsurgery, but for the year 2006, Coney Island Hospital reported zero cases in which a foreign object was mistakenly left in a patient after surgery.

Robert's son, Michael, was devastated. It was a surgery Michael didn't want him to have, but Asta desperately wanted to lose weight. The 6-foot, 375-pounder had tried all kinds of diets with little success.

"My life has never been the same. We were supposed to go into business together," Michael Asta said. "My family is heartbroken."

Asta never told his family what he was planning.

"None of us would have let him go," Michael Asta said.

The son said his father told him about the surgery a day after the operation — and said he was in a great deal of pain.

Robert called the hospital, but was told that pain after such an operation is a normal part of the recovery process.

Then on July 20, Asta received a call from the hospital asking him to come in for some further testing after lab tests came back with abnormal results.

The hospital found a piece of surgical tubing in material removed from Asta's body — an indication something had been left inside Asta postsurgery.

A CT scan was taken and the results were inconclusive. On July 23, Michael Asta received a call from his father's long-time girlfriend.

"She told me to come over because, she said, 'He feels very cold and I think he's dead,'" Asta said. When Asta arrived, his father was dead.

In response to the News' questions, the city Health & Hospitals Corp. insisted it didn't need to report this incident as "foreign object left in body" – a specific reporting category. Instead it was reported merely as "unexpected death."

HHC said surgical tubing was not left inside Asta, but an internal Coney Island Hospital document dated Aug. 22, 2006, that the family obtained in its lawsuit states, "Foreign Object left in body during surgical operation."

The autopsy report lists the cause of the death as a postoperative infection in the abdominal cavity that involved "retention of surgical tubing" in a surgical specimen.

Manner of death is listed as "therapeutic complication." Though the hospital didn't admit wrongdoing, the family's malpractice claim was settled for $675,000.

Asta left behind three adult children and two grandchildren.

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Gastric bypass surgery using robots reduce pain and speed recovery

Phoenix, AZ

Gastric bypass surgery has gone robotic at one Arizona hospital.

Using robots, doctors at Banner Gateway Medical Center can perform the surgery from inside the person's body, KPHO-TV reported.

"The robot allows you to perform the surgery (not only) in high definition, but also in three dimensions," said chief of surgery Dr. Rob Schuster.

Schuster said the procedure is less invasive and painful and it cuts the risk of infection.

Doctors use state-of-the-art technology with a three-dimensional image of the surgical area. The display controls the surgical instruments, working with the doctors' hands, wrists and eyes in real time.

"It really allows us to perform a more precise and perfect operation," Schuster said.

Schuster said the new procedure will result in shorter hospital stays and shorter recovery times, so patients are able to return more quickly to their normal routines.

Banner Gateway Medical Center is one of only a handful of hospitals in the country that use this technology.

KPHO's report did not address any additional costs or risks from the assisted surgery.

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ASMBS: Laparoscopic adjustable gastric banding less effective than gastric bypass and sleeve gastrectomy

Dallas, TX

Patients who underwent laparoscopic adjustable gastric banding achieved less weight loss and less improvement in comorbid conditions than those who had gastric bypass or sleeve gastrectomy.

Slightly more than half of gastric banding patients lost more than 50% of excess weight after five years compared with more than 90% of patients who underwent laparoscopic Roux-en-Y gastric bypass, Diego Awruch, MD, reported at the American Society of Metabolic and Bariatric Surgery.

Surgical failure, defined as less than 50% excess weight loss, was almost six times more common with gastric banding.

"Laparoscopic adjustable gastric banding was associated with fewer complications, but the percent weight loss at one and five years was inferior to laparoscopic Roux-en-Y gastric bypass," said Dr. Awruch, of Pontificia Universidad Catolica in Santiago, Chile.

"Surgical failure occurred in more than 40% of patients who underwent gastric banding, and 16% of the patients required surgical revision of the initial procedure," he said.

Similar disparities in weight loss occurred in the comparison of gastric banding and sleeve gastrectomy.

Across the entire range of body mass index (BMI), laparoscopic sleeve gastrectomy led to greater weight loss, said David Schumacher, MD, of Wright State University in Kettering, Ohio.

Dr. Awruch reported outcomes for 91 patients treated with laparoscopic Roux-en-Y surgery and 62 who underwent gastric banding from 2001 to 2003.

Five-year follow-up was available for 73.6% of the gastric bypass patients and 91.5% of the gastric banding patients.

Comparison of baseline characteristics showed that bypass patients weighed significantly more (106.4 versus 97.6 kg, P<0.001) and had a significantly higher BMI (39 versus 35, P<0.001).

Gastric bypass was associated with a higher rate of early complications (14.2% versus 1.6%, P=0.009). In addition, nine bypass patients required reoperation or endoscopic dilatation compared with one patient in the banding group.

Late complications occurred in 37.3% of bypass patients compared with 27.4% of gastric banding patients, but the difference did not reach statistical significance. A higher proportion of gastric banding patients required reintervention (23 of 62 versus 20 of 91).

Percent weight loss at five years averaged 92.9% with gastric bypass compared with 59.1% with gastric banding (P<0.001).

Dyslipidemia, insulin resistance, hypertension, and type 2 diabetes improved or resolved in 80% to 100% of bypass patients compared with 20% to 40% of the gastric banding group.

At five years, 94% of bypass patients and 54.4% of gastric banding patients had maintained >50% excess weight loss.

Dr. Schumacher reported outcome data for 104 patients who underwent laparoscopic sleeve gastrectomy and 227 who had gastric banding from January 2006 through August 2008. Follow-up data were 99% as of January 2009.

Among patients followed for at least 18 months (about half of the total), weight loss averaged 133.82 lb in the sleeve group versus 58.93 lb in the banding group.

For the same time interval, excess weight loss averaged 55.54% with sleeve gastrectomy versus 38.65% with banding.

Stratification of patients by baseline BMI showed that sleeve patients had a greater excess weight loss in patients with BMI more than 50 (50% versus 33%), 40 to 49 (68% versus 40%), and less than 40 (90% versus 43%).

Readmission rates were 6% of sleeve gastrectomy patients and 1.3% with gastric banding. One patient (0.96%) in the sleeve group required reoperation compared with 19 (8.4%) gastric banding patients.

"Laparoscopic sleeve gastrectomy appears to allow greater weight loss in all BMI classifications over time with fewer reoperations," said Dr. Schumacher. "The most efficient weight loss occurred in the lowest BMI classification.

"Laparoscopic sleeve gastrectomy can be used effectively as a primary operation in any weight classification, achieving a greater than 50% excess weight loss in all BMI subsets."

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Weight-loss surgery may decrease the risk of cancer in women

from CancerConsultants.com

Researchers from Sweden have reported that weight-loss surgery (bariatric surgery) was associated with a reduced incidence of cancer in obese women but not in obese men. The details of this study appeared in an early online publication in Lancet Oncology on June 24, 2009.[1]

Previous studies have suggested that obesity increases the risk of developing cancers of colon, rectum, liver, gallbladder, pancreas, breast, uterus, cervical, ovary, and kidney as well as lymphoid tumors such as non-Hodgkin’s lymphoma and multiple myeloma. It has been estimated that obesity increases the cancer death rate in men and women by more than 50%. It has been suggested that obesity causes 14% of all cancer deaths in men and 20% of all cancer deaths in women in the United States.

Weight loss surgery is usually the last resort for morbidly obese individuals when diets fail. Weight loss surgery refers to various procedures that restrict nutrient intake such as bands or bypasses. (See Wikipedia [http://en.wikipedia.org/wiki/Bariatric_surgery] for descriptions of the various surgical procedures currently being used.)

The current study evaluated the risk of cancer in 2,010 obese patients with a body mass index greater than 34 kg/m2 in men and greater than 38 kg/m2 in women who underwent weight loss surgery. Outcomes were compared with 2,037 controls who were comparably obese but did not opt for weight loss surgery. The median follow-up of this study was over 10 years.

* Weight loss surgery was associated with a 20 kg weight loss over the 10 years of observation compared with a 1.3 kg gain in controls.
* There were 117 cancers in the surgery group and 169 in the control group.
* There were 79 cancers in women in the surgery group and 130 in the control group.
* There were 39 cancers in men in the surgery group and 39 in the control group.
* Similar results were obtained when cancers developing in the first three years from surgery were excluded.

These authors concluded: “Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men.”

Comments: This is the first study to document a decreased risk of cancer following significant weight loss. It is very interesting that this decreased risk was limited to women. This may suggest that cancers in women are more hormonally dependent than in men. It has been speculated that hormones produced by fat may be the cause of increased breast, uterine, and ovarian cancer risk in obese individuals.

References:

[1] Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncology [early online publication]. June 24, 2009.

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