Ideas for new forums and stickies

NancyRN · July 20, 2006

This topic is showing up frequently enough that I suggest it become a forum: Over 50 (either age and/or BMI).

Ideas for stickies or FAQs: preop checklist (I've integrated 3 of these lists myself and seen at least 2 more since then); complications --

In the complications section, could we post the following sticky? Or maybe put it in the FAQs? We get many, many questions in the forums about complications. (By the way, what's the distinction between a sticky and an FAQ?)

Also, there's a fair amount of confusion in the forums about what's a complication and what isn't. Published complication rates vary depending on the institution and on how the surgeon defines complications. Inamed, for example, lists complications that add up to an 88% complication rate!! Enough to scare anyone away from getting a Lapband.

There is an excellent article that I think needs to be posted on our site, at least in excerpt form. It was posted recently by Dr. C and compares complication rates for Lapband, Rous-en-Y (RYGB) and biliopancreatic diversion with or without duodenal switch (BPD +- DS). The citation is: Parikh, Manish and others: "Objective Comparison of Complications Resulting From Laparoscopic Bariatric Procedures," J Am Coll Surg [Journal of the American College of Surgeons], 2006, 202:252-261. Here's my summary:

Parikh et al. have come up with a useful distinction between real complications (events that require diagnostic tests and/or therapeutic procedures to treat) and common postop occurrences that are annoying and troublesome, but are not as severe as complications. "Complications were distinguished from sequelae. Diarrhea, bloating, and gallstone formation were considered sequelae of the primary operations." They also use a standardized system of classifying complications, thus eliminating the common problem of different surgeons defining complications in different ways.

Conclusions: "Total complication rates were 9% for LAGB, 23% for RYGB, and 25% for BPD +- DS...The LAGB group had a significantly lower incidence of organ resection/longterm disability and death (0.2% LAGB, 2.1% RYBG, and 4.6% BPD +-DS)...Bariatric operation complication rates range from 9% to 25%; very few complications are serious. Laparoscopic adjustable gastric banding is the safest operation in terms of complication rate and severity when compared with laparoscopic Roux-en-Y gastric bypass or laparoscopic malabsorptive operations."

People sometimes ask which surgery is more effective at excess-weight loss. "Recent data would suggest that at least at 3 years, outcomes are very similar for LAGB and the RYGB...Given that weight loss is very similar between LAGB and RYGB, and that there is a significant difference in complication rates, patient preference for the safest operation seems reasonable."

This is very important information that doesn't really fit in the format of a discussion group post. Where could we put it?

NancyRN

P.S. Sounds like you've already figured out what should go in a sticky or FAQ in general, but I'm not sure whether you've decided regarding specific topics. I disagree that just letting some topics come to the top of the forums will be enough, because often earlier posts have more information or additional tips that could be included in a sticky or FAQ. If you need a volunteer to help you sort out the topics, I'd be happy to help.