Comparative Evaluation For those of you still deciding or who want some scientific fact

[Madam Reverie 2,958]

I posted this on another forum and felt it might be useful for other people to have a read of, if like me, you like your scientific facts.

Maybe the below will provide a bit of clarity as to the 'nuts and bolts' of some of the bariatric procedures and their long-term (within the limitations of the data) efficacy.

This first academic journal quoted was published in May 2013. So, it doesn't get more 'up to date' with regards to evaluating the comparative effectiveness in the three biggest weight loss procedures. I have only reproduced the abstract and have quoted the source below as the abstract covers the salient information we'd be interested in.

The second section is all about the metrics, with a snapshot of all the procedures being evaluated in a tabulated form (the table was removed from the cutting and pasting process, so read left to right) and the risks associated with the operations. The primary and secondary sources are also cited.

Better to make decisions based on rigorous scientific research, than hearsay and charasmatic sales pitches, I feel... Hope it helps.

Article 1:

Abstract: Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery.

Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities.

Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

SOURCE: Carlin A, Zeni T, Birkmeyer N, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals Of Surgery [serial online]. May 2013;257(5):791-797. Available from: MEDLINE with Full Text, Ipswich, MA.

Article 2:

September 2012: Morbidity and mortality associated with LRYGB, LSG, and LAGB from the ACS-BSCN dataset

LRYGB LSG LAGB 30-d mortality (%) 0.14 0.11 0.05 1-y mortality (%) 0.34 0.21 0.08 30-d morbidity (%) 5.91 5.61 1.44 30-d readmission (%) 6.47 5.40 1.71 30-d reoperation/intervention(%) 5.02 2.97 0.92

SOURCE: Data from Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011;254(3):410–20 [discussion: 420–2], in: Timothy D. J, Matthew M. H. Morbidity and Effectiveness of Laparoscopic Sleeve Gastrectomy, Adjustable Gastric Band, and Gastric Bypass for Morbid Obesity. Advances In Surgery [serial online]. n.d.;46(Advances in Surgery):255-268. Available from: ScienceDirect, Ipswich, MA

[nsquared 232]

Great information. Thank you for posting it.

[Madam Reverie 2,958]

No worries. Hope it is useful.