New options for obesity surgery

Novel techniques are now available that are safer

The number of gastrointestinal surgeries performed annually for severe obesity has increased from about 16,000 in the early 1990s to about 103,000 in 2003.   The frequency of these procedures has been fueled by the rise in the number of people who are morbidly obese, the failure of diets, exercise and medical therapy; and the advent of laparoscopic procedures.  Read more about these new procedures (somewhat technical, but useful).

Endoscopic Vertical Gastroplasty: A Novel Technique for Treatment of Obesity 

Current bariatric surgeries require accessing the internal organs through an incision in the abdomen. While this method has proven successful in the past, the introduction of a new technology currently used in treating gastroesophageal reflux disease is providing patients with an effective, less invasive alternative to gastric surgery.  (Related:  Gastric bypass surgery improves lifespan)

In this pilot study, researchers from the Hospital de Clinicas Caracas looked at the feasibility, efficacy and safety of endoluminal gastric suture, as well as its effect on reducing a patient’s body mass index (BMI) and co-morbidities. Ten overweight patients were clinically examined and their baseline BMI and morbidities were recorded. All 10 patients underwent a vertical gastroplasty (in which an endoscope is inserted through the mouth into the stomach) using the bard endoscopic suturing kit to significantly reduce the size of the stomach. The time to complete the ambulatory procedure ranged from 60 to 90 minutes and patients were then followed for three, six and nine months, with no significant complications reported.  (Related:  Circumferential abdominoplasty)

The report from the University of California Irvine Medical Center says that use of the laparoscopic technique, which involves several small abdominal incisions and insertion of a miniature camera to guide the surgery, jumped from about 2 percent of bariatric surgeries in 1998 to nearly 18 percent in 2002 simply because it is less invasive, reduces pain, and permits a quicker recovery.  (Related:  Tummy by Thermage)

Patients were able to return to work the following day. This pilot study demonstrates that the less-invasive method used in endoscopic intraluminal suturing is safe and effective. All patients achieved significant weight loss, ranging from 15 to 49 kilos (33 to 108 lbs.) at month nine. Researchers also observed a clinically significant reduction in the patients’ cholesterol and triglyceride levels. “The use of the bard endoscopic suturing kit during a vertical gastroplasty helped obese patients achieve significant weight loss without enduring an invasive procedure,” said Dr. Roberto Fogel, lead investigator on the study. “Since the abdominal wall is never cut, the surgery and recovery time is much faster. We hope to use this technology in the future to help bring promise to a larger population of obese patients."  (Related:  Alcohol after gastric bypass)

The Best Laparoscopic Bariatric Operation for Older Patients: Comparison of Outcome After the Band, Vertical Gastrectomy (VG), Roux-en-Y Gastric Bypass (RGB), and Duodenal Switch (DS) Operations

With the number of obesity surgeries increasing by 650 percent since the early nineties, researchers are examining the risks of the procedures for specific populations. The level of risk is related to the specific procedure and the patient's age, degree of obesity and other medical conditions. This study by researchers at California Pacific Medical Center attempts to determine which of the bariatric operations results in best outcome for patients over the age of 50.  (Related: How to lose weight during middle age)

Over a two-year period beginning in November 2002, one of four primary laparoscopic bariatric operations was performed on 166 patients aged 50 years and older. The types of operations performed included: Lap-Band (BAND), or a small silicone band placed around the upper section of the stomach; Vertical Gastrectomy (VG), during which 90-95 percent of the stomach is removed, leaving a small, thin, tube- like stomach approximately two ounces in size; Roux-en-Y Gastric Bypass (RGB), which restricts food intake by separating a small portion of the stomach with a line of staples; and Duodenal Switch (DS), which removes a large portion of the stomach to lower the capacity to store food and rearranges the small intestine to inhibit the absorption of calories.  (Related article:  While Medicare recognizes the risks of obesity surgery, it covers them for most patients)

More than half of the participants received the RGB operation, while 22, 19 and 8 percent received the BAND, VG and DS operations, respectively. The operation times were shortest for the BAND and VG procedures (both under two hours), versus RGB and DC, which both required more than two hours. After one year of follow-up, patients in the VG group showed the greatest weight loss (133 pounds) compared to those who received RGB (118 pounds), DC (114 pounds) and BAND (70 pounds). This data suggests that the best bariatric operation (Direct fat excision) for patients older than 50 years of age is vertical gastrectomy because it achieves the greatest weight loss results with the shortest operative time and the least number of complications.  “Bariatric surgery is not cosmetic, particularly in older patients. In many cases, it is the last option for patients whose obesity puts the m at risk for  serious health complications and even death,” said Paul T. Cirangle, M.D., a study investigator from California Pacific Medical Center. “It is important for us to know, especially as these surgeries become more prevalent, which operation is best for each patient.”

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