November 23, 2011 / 10:41 PM / 8 years ago

Safety data favors less-invasive weight-loss surgery

NEW YORK (Reuters Health) - Minimally-invasive weight-loss procedures seem to be safer than open bariatric surgery, according to researchers who analyzed past studies comparing the two methods.

The new report suggests that so-called laparoscopic surgery carries an 80 to 90 percent lower risk of infections and hernias, but that just as many people getting both procedures need the operation repeated. The risk of death from either appears to be low, researchers added.

“Within the surgical field it’s been almost accepted to a degree that laparoscopic is the way to go,” said Jennifer Reoch, a nursing graduate student at McGill University in Montreal, who led the new research. “Our study was to kind of give a little more weight to that decision.”

Researchers said that the less-invasive procedure, in which surgeons restrict the size of the stomach or bypass part of it using a few small cuts in the abdomen, is also a better choice for patients who want a quick recovery and who would prefer not to have a large scar from open surgery.

“I don’t see why someone would recommend the open surgery, given the data we have now,” Reoch told Reuters Health. “Having a wound infection and being stuck in a hospital... it’s not a difference of life or death, but for the patient it’s quite an awful experience.”

She and her colleagues compared the results from six studies, including a total of 510 morbidly obese patients, who were randomly assigned to get laparoscopic or open bariatric surgery and followed for the next one to two years. Most patients were female and were in their late 30s or early 40s, on average.

Rates of wound infection varied by procedure and study, happening in up to 14 percent of patients. Overall, the chance of getting an infection was 80 percent lower with laparoscopic surgeries.

Incisional hernias, which occur when the intestines push on the incision, didn’t happen after any laparoscopic procedures but did after four to 20 percent of open procedures.

Depending on the study, between zero and 42 percent of patients needed to have their surgery repeated, and rates were similar for the two procedures. In all studies combined, there were five deaths — two among patients getting laparoscopy, and three after open surgeries, according to findings published in the Archives of Surgery.

“What this paper really highlights is the overall safety of bariatric surgery,” even when the open procedure is used, said Dr. Anita Courcoulas, a bariatric surgeon from the University of Pittsburgh Medical Center who wasn’t involved in the new research.

Still, the findings reflect surgeons’ experience that the minimally invasive procedure is generally the better option, she told Reuters Health.

“There’s obviously been a dramatic increase in the number of laparoscopic procedures done in the last five to eight years. The laparoscopic approach certainly allows patients to be more active more quickly,” she said. “It allows them to return to work sooner.”

Courcoulas said bariatric surgery is currently recommended for people with a body mass index of 35 and other medical problems such as diabetes, or for people with a BMI of 40 without other conditions. For a five-foot, six-inch woman, that equates to 217 pounds or 248 pounds.

She and Reoch agreed that more long-term research is needed to see how the safety and effectiveness of different bariatric surgeries compare over more than just a couple of years.

In the studies that did report on weight loss, patients getting both laparoscopic and open bariatric surgery dropped an average of 75 to 90 pounds.

SOURCE: Archives of Surgery, online November 21, 2011.

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