Laparoscopic gastric bypass surgery for patients with type 2 diabetes was once considered a high-risk procedure. But a new study shows that complication and death rates for the procedure is comparable to some of the safest and most commonly performed surgeries in the United States.
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Researchers from Cleveland Clinic’s Bariatric and Metabolic Institute reviewed a national database of 66,678 patients with diabetes who had various surgical procedures between 2007 and 2012. The procedures included laparoscopic gallbladder surgery, appendectomy, partial colon resections, hysterectomy, heart surgery and total knee replacement.
The researchers compared the complication and death rates of these procedures to those of 16,509 patients who had laparoscopic gastric bypass.
In this procedure, surgeons use minimally invasive surgical techniques to reduce the size of the stomach and permit food to bypass part of the small intestine. This reduces the amount of food patients can eat at one time, limits food absorption and is associated with favorable hormonal changes. The procedure results in weight loss and, ultimately, remission or improvement of the patient’s diabetes.
The comparison showed:
- The 30-day complication rate for gastric bypass was 3.4 percent – about the same as for laparoscopic gallbladder surgery and hysterectomy.
- Hospital stays and readmission rates were similar to laparoscopic appendectomy.
- The month-long death rate for metabolic or diabetes surgery was 0.30 percent (three in every 1,000 diabetic patients), which is about that of total knee replacement and about one-tenth the risk of death after cardiovascular surgery.
- Gastric bypass patients had significantly better short-term outcomes in all examined variables compared to laparoscopic colon resections.
Favorable risk-to-benefit ratio
“The perception has been that gastric bypass is a very risky operation. But the reality is that it is as safe – if not safer – than many of the most commonly performed surgeries in America,” says study co-author Ali Aminian, MD, Clinical Scholar of Advanced Metabolic and Diabetes Surgery at Cleveland Clinic.
For patients with type 2 diabetes, gastric bypass procedures can have a nearly immediate effect – occurring in a matter of hours or days, and long before weight loss occurs, Dr. Aminian says. Sometimes patients walk out of the hospital without medications.
“The risk-to-benefit ratio of gastric bypass for diabetes and obesity is very favorable,” Dr. Aminian says. “There’s significant weight loss, diabetes improvement or remission, and a relatively low complication and mortality rate.”
In addition, earlier intervention with metabolic surgery may eliminate the need for some later higher-risk procedures to treat cardiovascular complications of diabetes, Dr. Aminian says.
Another Cleveland Clinic study published this year in The New England Journal of Medicine found diabetes remission rates three years after bariatric surgery were 35 percent, compared to zero for patients treated with drugs.
Findings from the new study, “How Safe is Metabolic/Diabetes Surgery?” were presented this week at the annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) and appear in the journal Diabetes, Obesity, and Metabolism.
The study’s authors say the database used in the study includes only short-term postoperative outcomes. More studies on the long-term safety of surgery are necessary, the researchers say.
More than 78 million adults were obese in 2011–2012, according to the Centers for Disease Control and Prevention (CDC).
People with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death, compared to people who have a healthy weight. These people also have an increased risk of developing more than 40 obesity-related diseases and conditions, including type 2 diabetes, heart disease and cancer.
Studies show that metabolic/bariatric surgery procedures, such as gastric bypass, are the most effective and longest-lasting treatment for morbid obesity and co-morbidities including diabetes.
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