Weight-Loss Surgery Not Without Risks

Age and type of surgery seem to be the key factors, study finds

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By Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 22, 2006 (HealthDay News) -- Weight-loss surgery, called bariatric surgery, has become an increasingly popular solution to obesity, but as with any invasive procedure, there are some risks, according to a new report.

Increasing age and a type of surgery known as a "duodenal switch" are associated with an increased risk of complications after surgery, the study found.

"With every year of increasing age after the age of 60, there was a slightly increasing risk for complications," said lead author Dr. Robert W. O'Rourke, an assistant professor of surgery at Oregon Health & Science University in Portland. In addition, patients who chose a duodenal switch rather than a gastric bypass had a two-fold increased risk of complications, he added.

For the study, O'Rourke's team collected data on 452 patients -- 372 women and 80 men, with an average age of 44 -- who had had bariatric surgery. The patients received either gastric bypass surgery, which sections off a small portion of the stomach into a pouch that connects directly to the small intestine, or a duodenal switch. In this less-common procedure, part of the stomach is removed and a slightly larger pouch is left. In addition, an intestinal bypass-like-procedure is done that attaches the first part of the small intestine to the lower part of the small intestine.

During more than one year of follow-up, the patients lost an average of 54 percent of their excess weight. However, four patients died, 10 percent had major complications and 13 percent had minor complications. Patients who were 60 or older were more likely to develop complications than younger patients. And, the duodenal switch procedure was associated with more complications than gastric bypass surgery, the researchers found.

The findings appear in the March issue of the Archives of Surgery.

O'Rourke said that most of his patients receive gastric bypass surgery because of the data cited in the study. "The gastric bypass is the gold standard," he said. "The gastric bypass is the operation most often done in this country."

Dr. Shawn Garber, chief of bariatric surgery at Mercy Medical Center in Rockville Centre, N.Y., concurs that gastric bypass is the preferred procedure.

"I personally do not offer the duodenal switch procedure, because I feel the morbidity is much higher, even though some studies have shown that the weight loss is better than gastric bypass," he said.

"In this study, there was no better weight loss with the duodenal switch," Garber added.

Another study in the same issue of the journal looked at the potential for beneficial changes in blood pressure after bariatric surgery.

"Blood pressure doesn't always change after gastric bypass surgery," said co-author Madelyn H. Fernstrom, director of the University of Pittsburgh School of Medicine's Weight Management Center. "Most people do see some improvement. But it all depends on your blood pressure before surgery."

In this study, Fernstrom and her colleagues reviewed the medical charts of 347 patients who had undergone bariatric surgery between 1992 and 2001.

About half the patients had high blood pressure before surgery. After surgery, these patients saw a slight drop in systolic blood pressure and a significant drop in diastolic blood pressure, the researchers found.

Patients who didn't have high blood pressure and those taking blood pressure medications had smaller drops in blood pressure than those with high blood pressure who had not been taking medications prior to the operation.

Of the 103 patients who were taking blood-pressure medication before surgery, 35 were able to stop taking the drugs after surgery, Fernstrom's group found.

"Improvement in blood pressure depends on where you started," Fernstrom said.

Garber said: "This article confirms that surgery for morbid obesity results in significant improvement in patients' weight, which results in improvement of their hypertension.

"In the long run, weight loss improves patients' medical problems like diabetes, hypertension, and sleep apnea, and decreases the number of medications that patients need to take," he added. "This will lead to increases in the lifespan of patients that lose weight and resolve their medical co-morbidities. Surgery for obesity is the only effective means for long-term weight loss in patients that suffer from morbid obesity."

More information

The American Obesity Association can tell you more about weight-loss surgery.

SOURCES: Robert W. O'Rourke, M.D., assistant professor, surgery, Oregon Health & Science University, Portland; Madelyn H. Fernstrom, Ph.D., director, Weight Management Center, University of Pittsburgh School of Medicine; Shawn Garber, M.D., chief, bariatric surgery, Mercy Medical Center, Rockville Centre, N.Y.; March 2006 Archives of Surgery

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