Gastric Bypass Success Sparks Debate

Dec. 15 -- SUNDAY, Dec. 14 (HealthDay News) -- Recent studies showing that gastric bypass surgery extends the lives of obese patients is forcing surgeons to make tough decisions about who should go under the knife and who shouldn't.

Internists, cardiologists and endocrinologists, more than ever, are referring patients who traditionally haven't been candidates for the weight-loss surgery, also called bariatric surgery.

"I am being asked to operate on 78-year-olds with co-morbidities of heart disease and diabetes," said Dr. Edward H. Phillips, executive vice chairman of the Department of Surgery and a surgeon at the Center for Weight Loss at Cedars-Sinai Medical Center in Los Angeles. Phillips questions whether these patients will benefit, or if the damage has already been done.

"So, while it is obvious a 30-year-old will benefit, at what age is too old?" he asked.

The success of gastric bypass is also stoking debate about its use as a treatment for type 2 diabetes. Mounting evidence suggests this type of surgery may dramatically improve patients with the disease, freeing them from a lifetime of diabetes medications.

"There's more acceptance now of the concept that bariatric surgery is a truly life-saving type of therapy rather than just a way to shed pounds," said Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery at Weill Cornell Medical College in New York City.

Still, more long-term studies are needed, and clinicians and policymakers must reach a consensus on who should have access to this type of surgery, noted Rubino, who directed the 1st World Congress on Interventional Therapies for Type 2 Diabetes, held in New York City in September.

An estimated 205,000 bariatric surgeries were performed in the United States in 2007, according to the American Society for Metabolic & Bariatric Surgery (ASMBS). That's an increase of almost 20 percent from two years earlier.

If patients commit to making necessary changes in their diet and exercise regimens, gastric bypass surgery can provide long-term, consistent weight loss, according to the Mayo Clinic.