Gastric bypass may save lives over time

Last Updated: 2015-01-07

By Shereen Lehman

(Reuters Health) - In a small long-term study, obese patients who had gastric bypass surgery were half as likely to die as those who didn't have the surgery, researchers found.

The investigators saw little difference in mortality rates for the first two to three years, but 10 years after gastric bypass surgery, even diabetic patients had significantly better survival if they had the surgery.

"There's really limited long-term follow-up data, especially comparing bariatric surgery to no surgery or the usual medical care," Dr. Peter Hallowell, the study's senior author, told Reuters Health.

"We're hoping to fill that void with a study like this," said Hallowell, a surgeon with the University of Virginia Health System in Charlottesville.

As reported online December 23 in the American Journal of Surgery, the study team carefully matched 430 obese patients who had gastric bypass surgery to 401 control patients.

They found very little difference in the first two years after the surgery (three years for diabetes patients).

But by ten years of follow-up, 6.5% of the surgery patients had died, compared to almost 13% of the patients who did not have the surgery.

When the researchers looked just at patients with diabetes, they found that 10% of the gastric bypass group had died, compared to 19% of the matched non-surgery patients.

"If you've tried dieting, exercise and medical management and that's all failed, then you really should consider a surgical option - especially if you have diabetes," Hallowell said.

Currently, only one or two percent of patients who are eligible for weight loss surgery ever have it, he noted.

"We really have a long way to go both to educate the public, educate legislatures and educate (insurance companies) that this is safe, it's effective, and it increases long-term survival," he said.

Hallowell said bariatric surgery is really quite safe.

"The current data of what we consider 'early mortality' in the first 30 days is basically about two people in about 1000, which is less than the mortality rate associated with having a gallbladder removed and it's getting down on the order of having your appendix removed," he said.

Hallowell said sleeve gastrectomy was the most popular bariatric operation in 2014, but the current study only looked at gastric bypass.

"Unfortunately for those (new) procedures the data is only three or four years old, so we just didn't have any patients that we could include in this type of study to be able to go out 10 years," he said.

Martin Gulliford, a bariatric researcher at King's College London in the UK, said there is growing appreciation of the potential of surgery for severe obesity.

But, he said, the new findings must be treated with some caution, as there were only 26 patients who died in the surgical group, and 51 in the control group.

"Despite the carefully conducted matching procedure, there may have been unmeasured differences between the two groups, other than surgery, that influenced patient outcomes," he added.

Still, Gulliford said, the new data add to earlier findings that suggest weight loss surgery may be associated with lower mortality in people with severe obesity.

SOURCE: http://bit.ly/140T0cl

Am J Surg 2014.