Bariatric surgery cuts pounds, adds years

NEW YORK (Reuters Health) - Obese individuals may add years to their lives by drastically cutting pounds with bariatric surgery, according to a new review of clinical trials of popular gastric bypass and banding procedures.

Italian researchers found that undergoing one of the two operations reduced a patient's odds of dying by nearly half over an average study period of seven to eight years.

Bariatric surgery can produce a sustained reduction in body weight, at a level that is very difficult to achieve with other common obesity-management strategies, Dr. Luca Busetto of the University of Padova, in Italy, told Reuters Health in an e-mail.

This can be life-saving, as people who are morbidly obese carry a two-to-three fold higher risk of death compared to normal-weight people, due in large part to obesity-related conditions such as diabetes and hypertension, added Busetto, who was not involved in the review but led one of the included studies.

About 220,000 Americans underwent some form of weight-loss surgery in 2009, most often gastric bypass, according to the American Society for Metabolic and Bariatric Surgery. The procedures cost between $14,000 and $26,000, with the price tag for bypass usually slightly higher than for banding.

In gastric bypass, a patient's stomach is reduced from about the size of a football to that of a golf ball. This smaller stomach is also attached to the middle of the small intestine, "bypassing" a section of the intestinal tract and thereby limiting calorie absorption. Gastric banding, on the other hand, involves wrapping a saline-filled silicone band around the upper part of the stomach, causing patients to feel full more quickly. Saline can be added or removed, making the constriction adjustable.

To help guide doctors and their patients in choosing the best strategy, Dr. Antonio Pontiroli and his colleague Alberto Morabito, both of the University of Milan, looked to the literature on both gastric bypass and banding. They identified eight trials, which included an average of seven-and-a-half years of follow-up on a total of more than 44,000 men and women. About 14,000 of the participants actually underwent bariatric surgery, the rest served as control subjects for comparison.

The researchers tallied about 3,300 deaths across the studies: 2.8 percent of those who had a bariatric procedure and 9.7 percent among similar patients who did not have surgery. This translated into 45 percent lower odds of dying with bariatric surgery.

A similar benefit was found when the team looked specifically at heart-related deaths.

Overall, death rates were comparable for the approximately 10,000 gastric banding and 4,000 gastric bypass surgeries, although the protective effects on heart-related deaths differed: compared to no surgery, banding provided 29 percent lower odds of heart-related death versus a 52 percent risk reduction with bypass, report the researchers in the Annals of Surgery.

Busetto noted that gastric bypass generally provides "more rapid and important weight loss" than banding. On the flip side, bypass is irreversible and introduces a greater chance of severe complications and even surgery-related death. These risks, however, are still very small: about one in a thousand patients dies during a gastric bypass.

Further, while either operation may cost more than other treatments in the short term, said Busetto, "weight loss obtained by bariatric surgery may also save money over time."

After drastic reductions in pounds, patients tend to find that they need fewer medications for the treatment of obesity-related conditions, and that they take fewer sick days.

For obese individuals considering bariatric surgery, Busetto recommends going to a center that has the ability to perform both bypass and banding and making sure there is an honest discussion of the short- and long-term pros and cons of each procedure before choosing one.

"Patients should be aware that bariatric surgery is highly effective, but it is not a 'magic bullet,'" he added. "Failures and complications still exist."

SOURCE: bit.ly/f3YM1H Annals of Surgery, online January 17, 2011.