Sleeve gastrectomy dominates in weight-loss surgeries in U.S.

Last Updated: 2015-11-09

By Megan Brooks

NEW YORK (Reuters Health) - Sleeve gastrectomy is now the most popular bariatric surgery in the United States, surpassing laparoscopic gastric bypass, according to new research.

"We've seen a real shift in the world of bariatric surgery with the emergence of the sleeve gastrectomy," Dr. Philip Schauer, study investigator and director of the Cleveland Clinic Bariatric and Metabolic Institute in Ohio, noted in a statement.

"In just four years, there's been a five-fold increase in the number of these operations. This is likely due to a combination of factors including better insurance coverage and more data demonstrating its safety and effectiveness in treating obesity and related diseases," Dr. Schauer said.

"Patients are attracted to this procedure because from their point of view it seems to be less invasive as opposed to gastric bypass," he noted in an interview with Reuters Health. "And there are surgeons who prefer sleeve gastrectomy. It's an easier operation, requires less training."

The research was presented November 4 at ObesityWeek 2015 hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

"We saw a trend (in sleeve gastrectomy) in our own practice at the Cleveland Clinic and wanted to see what it looked like nationally," Dr. Schauer told Reuters Health.

Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, he and his colleagues identified nearly 72,000 patients with a body mass index (BMI) of at least 35 who had bariatric surgery between 2010 and 2013. Most were middle-aged women.

In 2010, sleeve gastrectomy accounted for 9.3% of procedures, while laparoscopic gastric bypass made up 58.4% and gastric band 28.8%. By 2013, 49% of the procedures were sleeve gastrectomy, 43.8% were gastric bypass, and just 6% were gastric band procedures. "We are seeing a dramatic drop in gastric banding," Dr. Schauer commented.

For patients with type 2 diabetes, gastric bypass procedures increased from 30.4% in 2010 to 33.3% in 2013. At the same time, patients with diabetes having sleeve gastrectomy dropped from 26.6% to 22.5%.

"Although we are seeing an increase in the sleeve gastrectomy, it still appears that in patients with diabetes or people who are heavier, people in the 150-pound overweight category, there is still quite a bit of interest in the gastric bypass. It still has a very strong foothold in that market of patients" and rightly so, Dr. Schauer said.

Overall, "sleeve gastrectomy is now the most common procedure for weight loss in the U.S., and that's the first time that's ever happened," Dr. John M. Morton, president of the ASMBS and chief of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine in California, who wasn't involved in the study, noted in an interview with Reuters Health.

He cited some of the same drivers as Dr. Schauer.

"The surgery is easier to perform from a technical standpoint (and) there may be some patient preference issues around it. It's less involved than the bypass and the complication rate is a little bit lower. That being said, just like anything in surgery, there is a risk-benefit equation and while there is a slightly higher risk of complications with gastric bypass there is a corresponding increase in effectiveness, more resolution of diabetes and more weight loss," said Dr. Morton.

"In the overall picture, when it comes to safety, for all of bariatric surgery it is quite good. The mortality rate overall is 0.1%, which is equivalent to removal of a gallbladder," Dr. Morton told Reuters Health.

"Each of the bariatric operations has a place in the treatment of obesity and related diseases," he added in a conference statement. "The answer as to which one is right for which patient is based on a careful evaluation of the risks and benefits of each procedure and the health status of the patient."