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Inside Tract - What Physicians Need to Know About Bariatric Surgery
InsideTract Fall 2009
What Physicians Need to Know About Bariatric Surgery
Date: December 15, 2009
Thomas Magnuson and Michael Schweitzer
Bariatric surgery has evolved dramatically since it was first developed in the 1960s to manage morbid obesity. With all that’s changed, it’s important to understand patient eligibility requirements as well as what the myths are.
How has bariatric surgery changed in the last decade?
One of the more significant changes has been the introduction of laparoscopic bariatric procedures. We’re now using special endoscopic instruments that require only five or six small incisions versus the open surgery, which means an incision from below the breastbone to above the navel. Though the techniques are similar, the laparoscopic approach may mean less postoperative pain and fewer wound complications, which help patients return to their daily activities faster.
We’re also performing the StomaphyX procedure, an endoscopic technique for patients who’ve had bariatric surgery in the past but who’ve regained their weight. It lets us suction a small section of the stomach and create a plication to help reduce stomach pouch volume.
What’s the biggest misperception?
We’re often asked about safety. The reality is that the risk of being morbidly obese is far greater than the risk of surgery. In centers of excellence, the death rate is less than 1 percent; at Johns Hopkins it’s less than 0.5 percent. A recent New England Journal of Medicine article also reported a 40 percent reduction in mortality seven years following gastric bypass compared with those who remained morbidly obese.
Who are the candidates?
Bariatric procedures are not performed for cosmetic reasons but to improve overall health. Patients must have a body mass index of at least 35 and a medical problem related to obesity. They must be willing to commit to healthy eating and exercise. These operations really are tools to help patients lose weight, so behavior modification is extremely important to overall success. The best programs address weight loss from all angles—behavioral, physical, medical and surgical.
What about outcomes?
We’ve shown that with current procedures, outcomes are excellent and safe and much improved over results in the past. We’ve refined the techniques and created clinical pathways that look at treatment every step of the way. What’s especially compelling is that after gastric bypass, patients lose 70 percent of their excess weight, and more than 70 percent of patients who have diabetes are able to discontinue their medications—including insulin. And, bariatric surgery has been shown to resolve other comorbidities as well and result in improved quality of life and overall health.