Skip to main content

Advertisement

Log in

Factors in Selecting the Optimal Bariatric Procedure for a Specific Patient and Parameters by Which to Measure Appropriate Response to Surgery

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Bariatric operations are increasingly being used to induce weight loss and ameliorate or cure most of the morbidities that accompany obesity. These procedures not only produce substantial weight loss (>50% body weight), but they cure or ameliorate the comorbidities (diabetes type 2, hypertension, sleep apnea, hyperlipidemia) in the vast majority of patients. These procedures can usually be performed laparoscopically with a mortality of less than 0.5% and a hospital stay of 1 to 3 days. Presently they are the only effective treatment for weight loss in the extremely obese patient (body mass index ≥ 35).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Solomon CG, Manson JE: Obesity and mortality: a review of the epidemiologic data. Am J Clin Nutr 1997, 66(Suppl):10444S–10450S.

    Google Scholar 

  2. Ogden CL, Carroll MD, Flegal KM, et al.: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006, 295(13):1549–1555.

    Article  CAS  PubMed  Google Scholar 

  3. Friedrich MJ: Epidemic of obesity expands its spread to developing countries. JAMA 2002, 287(11):1382–1386.

    Article  CAS  PubMed  Google Scholar 

  4. Nguyen NT, Magno CP, Lane KT, et al.: Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg 2008, 207(6):928–934.

    Article  PubMed  Google Scholar 

  5. • Stewart ST, Cutler DM, Rosen AB: Forecasting the effects of obesity and smoking on US life expectancy. N Engl J Med 2009, 361(123):2252–2260. This article describes an epidemiology study documenting the effect of obesity on longevity.

    Article  CAS  PubMed  Google Scholar 

  6. Picot J, Jones J, Clegg AJ, et al.: The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009, 13(41):1–190, 215–357.

    CAS  Google Scholar 

  7. •• Keating CL, Dixon JB, O’Brien PE: Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care 2009, 32(4):580–4. This article presents a cost analysis of bariatric surgery versus medical therapy for treatment of type 2 diabetes mellitus. This is a randomized, controlled study. Over 15 years, the cost was slightly less for surgically treated patients and the diabetes was more effectively treated in the surgical therapy group.

    Article  PubMed  Google Scholar 

  8. Christou NV, Sampalis JS, MacLean LD, et al.: Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004, 240(3):416–424.

    Article  PubMed  Google Scholar 

  9. • Adams TD, Gress RE, Hunt SC, et al.: Long-term mortality after gastric bypass surgery. N Engl J Med 2007, 357(8):753–761. This article describes a retrospective study examining two large cohorts matched for age, sex, and BMI. One cohort had a bariatric procedure; the other cohort was not treated with surgery. Long-term mortality was reduced in the cohort undergoing a bariatric procedure.

    Article  CAS  PubMed  Google Scholar 

  10. Maru S, van Der Schouw YT, Peeters PHM, et al.: Body mass index and short-term weight change in relation to mortality in Dutch women after age 50. Am J Clin Nutr 2004, 80:231–236.

    CAS  PubMed  Google Scholar 

  11. •• Sjostrom L, Narbro K, Carlsson L, et al.: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007, 357(8):741–752. This article describes a prospective study with more than 2000 patients in each group of obese patients. One group had bariatric surgery, the other did not. Mortality was decreased and weight loss increased in those patients undergoing bariatric surgery. The first prospective study demonstrating increased long-term survival following bariatric surgery.

    Article  PubMed  Google Scholar 

  12. Martin LF: The evolution of surgery for morbid obesity. In Obesity Surgery. Edited by Martin LF. New York: McGraw Hill; 2004:15–48.

    Google Scholar 

  13. Gastrointestinal Surgery for Severe Obesity. NIH Consensus Development Conference Statement March 25–27, 1991.

  14. • Farrell TM, Overby DW, Richardson WS: Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc 2009, 23:920–949. This article is a well-documented review outlining the present bariatric procedures, their advantages, and drawbacks.

    Article  Google Scholar 

  15. Buchwald H, Avidor Y, Schoelles K, et al.: Bariatric surgery: A systematic review and meta-analysis. JAMA 2004, 292(14):1724–1737.

    Article  CAS  PubMed  Google Scholar 

  16. Nguyen NT, Goldman C, Rosenquist J, et al.: Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001, 234:279.

    Article  CAS  PubMed  Google Scholar 

  17. •• The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium: Perioperative safety in the longitudinal assessment of bariatric surgery. N ENGL J MED 2009, 361(5):445–454. This prospective study compared the safety of LAGB, RYGBP, and BPD performed at six centers in the United States.

    Article  Google Scholar 

  18. Salameh JR: Bariatric surgery: past and present. Am J Med Sci 2006, 331(4):194–200.

    Article  CAS  PubMed  Google Scholar 

  19. Mason EE, Ito C: Gastric bypass. Ann Surg 1969, 170:329.

    Article  CAS  PubMed  Google Scholar 

  20. Griffen WO, Young VL, Stevenson CC: A prospective comparison of gastric and jejuno-ileal bypass procedures for morbid obesity. Ann Surg 1977, 186(4):500–509.

    Article  PubMed  Google Scholar 

  21. Martin LF: Gastric restrictive procedures: gastroplasties and bands. In Obesity Surgery. Edited by Martin LF. New York: McGraw Hill; 2004:193–200.

    Google Scholar 

  22. Chapman AE, Kiroff G, Game P, et al.: Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surg 2004, 135(3):326–351.

    Article  Google Scholar 

  23. Mittermair RP, Obermuller S, Margreiter R, et al.: Results and complications after Swedish adjustable gastric banding—10 years experience. Obes Surg 2009, 19(12)1636–1641.

    Article  PubMed  Google Scholar 

  24. Fuks D, Verhaeghe P, Brehant O: Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surg 2009, 145(1):106–113.

    Article  Google Scholar 

  25. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al.: Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 2010 2010, 20(5):535–540.

    Google Scholar 

  26. Deitel M, Crosby RD, Gagner M: The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 2008, 18:487–496.

    Article  PubMed  Google Scholar 

  27. Gumbs AA, Gagner M, Dakin G, Pomp A: Sleeve gastrectomy for morbid obesity. Obes Surg 2007, 17(7):962–969.

    Article  PubMed  Google Scholar 

  28. Prachand VN, Ward M, Alverdy JC: Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or + 50 kg/m2) compared with gastric bypass. J Gastrointest Surg 2010, 14(2):211–220.

    Article  PubMed  Google Scholar 

  29. Søvik TT, Taha O, Aasheim ET, et al.: Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity. Br J Surg 2010, 97(2):160–166.

    Article  PubMed  Google Scholar 

  30. Strain GW, Gagner M, Pomp A, et al.: Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis 2009, 5(5):582–587.

    Article  PubMed  Google Scholar 

  31. Lynch RJ, Eisenberg D, Bell RL: Metabolic consequences of bariatric surgery. J Clin Gastroenterol 2006, 40(8):659–668.

    Article  PubMed  Google Scholar 

  32. Wee CC: A 52-year-old woman with obesity: review of bariatric surgery. JAMA 2009, 302(10):1097–1104.

    Article  CAS  PubMed  Google Scholar 

  33. •• Tice JA, Karliner L, Feldman MD, et al.: Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med 2008, 121(10):885–893. A timely meta-analysis of studies comparing LRYGBP with LAGB. The study slightly favors LRYGBP.

    Article  PubMed  Google Scholar 

  34. Jones DB, Provost DA, Schirmer B, et al.: Optimal management of the morbidly obese patient. Surg Endosc 2004, 18:1029–1037.

    Article  CAS  PubMed  Google Scholar 

  35. Needleman BJ, Happel LC: Bariatric surgery: Choosing the optimal procedure. Surg Clin N Am 2008, 88:991–1007.

    Article  PubMed  Google Scholar 

  36. Favretti F, Ashton D, Busetto L, et al.: The gastric band: first-choice procedure for obesity surgery. World J Surg 2009, 33(10):2039–2048.

    Article  PubMed  Google Scholar 

  37. Christou N, Efthimiou E: Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada. Can J Surg 2009, 52(6):E249–E258.

    PubMed  Google Scholar 

  38. Treadwell JR, Sun F, Schoelle K: Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg 2008, 248(5):763–776.

    Article  PubMed  Google Scholar 

  39. Varela JE, Wilson SE, Nguyen NT: Outcomes of bariatric surgery in the elderly. Am Surg 2006, 72(10):865–869.

    PubMed  Google Scholar 

  40. Hollenbeak CS, Rogers A, Barrus B, et al.: Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery 2008, 144(5):736–743.

    Article  PubMed  Google Scholar 

  41. Nguyen NT, Root J, Zainabadi K, et al.: Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005, 140:1198–1202.

    Article  PubMed  Google Scholar 

  42. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 2006, 331(4):219–225.

    Article  PubMed  Google Scholar 

  43. Toh SY, Zarshenas N, Jorgensen J: Prevalence of nutrient deficiencies in bariatric patients. Nutrition 2009, 25:1150–1156.

    Article  CAS  PubMed  Google Scholar 

  44. • Aasheim ET: Wernicke encephalopathy after bariatric surgery. Ann Surg 2008, 248:714–720. Survey documenting the incidence of Wernicke’s encephalopathy following bariatric surgery. Although a rare complication, it can be devastating.

    PubMed  Google Scholar 

  45. Duffrey BG, Pedro RN, Makhlouf A, et al.: Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis. J Am Coll Surg 2008, 206(6):1145–1153.

    Article  Google Scholar 

  46. Sinha MK, Collazo-Clavell ML, Rule A, et al.: Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Internat 2007, 72:100–107.

    Article  CAS  Google Scholar 

  47. DeMaria EJ: Bariatric surgery for morbid obesity. N Engl J Med 2007, 356(21):2176–2183.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Clifford W. Deveney.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Deveney, C.W., Martindale, R.G. Factors in Selecting the Optimal Bariatric Procedure for a Specific Patient and Parameters by Which to Measure Appropriate Response to Surgery. Curr Gastroenterol Rep 12, 296–303 (2010). https://doi.org/10.1007/s11894-010-0117-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-010-0117-0

Keywords

Navigation