Study: Bariatric Surgery A Safe Weight-Loss Option

July 30, 2009— -- Jaylene Verhelst, 33, worried that like many in her family before her, obesity would take her on a path towards heart disease and diabetes.

Hollace Jacovetty, 61, feared that she was too old to take any drastic measure to reduce her weight.

But both women were able to lose 100 pounds after undergoing a major operation known as bariatric surgery.

The procedure has shown results in helping obese but determined patients lose weight and keep most of it off. However, it has drawn some negative attention for concerns about its safety.

Verhelst, who underwent the operation at Baylor University Medical Center at Dallas, said seeing one of her brothers after he underwent a bariatric operation known as laparoscopic banding reassured her.

"One day my brother had called and said he had the lap band, and it didn't really kill anybody," she said.

For Jacovetty, reassurances came from the literature given to her by the Cleveland Clinic, where she had her operation done.

"What helped me so much is what they published," she said. "It was like a bible to me."

Bariatric surgery is far from a quick fix for weight loss. Proper preparation for the surgery requires wholesale lifestyle changes like developing good eating habits and performing plenty of exercise. And those changes should continue after the operation to minimize risks, including weight gain, and to increase the chances for significant weight loss.

Jacovetty said that in the two weeks preceding her operation, she could only consume liquids.

"It's not the easy solution -- it's not the quick fix at all," she said. "You really have to be determined and I was."

And now, a major study from some of the nation's best centers for bariatric surgery says the operation is not just a possibility for those needing to lose weight, but a relatively safe one.

Researchers in the new study analyzed results from 4,610 patients who were undergoing bariatric surgery for the first time at centers designated as "highly skilled," and who were having either a Roux-en-Y gastric bypass or a laparoscopic adjustable gastric banding performed.

They found that the risk of death following the surgery was 0.3 percent, with 4.3 percent of all patients having some complication.

"The basic finding is that bariatric surgery as done in the centers participating in the NIH consortium is safe -- not perfect," said Dr. Bruce Wolfe, a professor of surgery at Oregon Health & Science University and one of the study authors. Of the rate of complications, he said, "As major surgery goes, that's very low.

"There's data that weight loss clearly benefits the health of severely overweight people, and surgery is the most effective way to weight loss," he said.

In addition to rates of complications, the researchers sought to find out which patients were most at risk for those complications.

The researchers found that the patients most likely to have a complication were those who had histories of blood clots; suffered from sleep apnea; had difficulty walking 200 feet with a cane or were unable to walk that distance; or were extremely obese.

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The study findings appear in the most recent issue of the New England Journal of Medicine.

Bariatric Surgery Risks vs. Rewards

One important finding of the study was that gastric banding was a slightly safer form of the operation, and should be used for patients at higher risk of complication, Wolfe said, adding that the study could guide doctors when informing patients of the risks.

"If we just give them the average ... that's fair enough," Wolfe said. "But suppose the patient has all four of the risk factors that we are talking about and they have to have the higher risk procedure, then it really is inaccurate to tell that patient that their risk is the same as the average patient."

Dr. Philip Schauer, past president of the American Society for Metabolic and Bariatric Surgery and a professor of surgery at the Cleveland Clinic Lerner College of Medicine, said the study will help inform patients and doctors of risks in the future.

"Surgery is quite safe, considering the relatively high risk of these severely obese patients," he said, noting that coronary bypass surgery carries a risk of death 10 times greater than the risk this study found for bariatric surgery.

"For that mortality risk, a patient is receiving a great deal of benefit from that," he said.

Schauer was a participating doctor in the early days of the study, as he performed surgeries at the University of Pittsburgh -- one of the centers involved.

Calling the study "an excellent start," Dr. Christine Ren Fielding, an associate professor of surgery at New York University Langone School of Medicine, said the study gives doctors more information they want about the procedure.

"This is only the very first answer of many questions that we have regarding bariatric surgery," she said. "This study is focused on a very specific question: What is the short-term (30-day) mortality and complication rate of bariatric surgery."

For Dr. Eric J. DeMaria, director of endosurgery and bariatric surgery at Duke University, that short-term risk is a critical step in assessing risk.

"Most risk accompanying a surgical intervention is demonstrated to occur in the short term following the procedure," he said.

"The very low mortality of bariatric procedures found in this study are consistent with several recent publications which confirm that risk of complications and mortality of bariatric surgery has decreased significantly," said DeMaria.

For Verhelst, the risk calculations were not that hard, even after she was informed.

"I just read [about the surgery]," she said. "Of course, like I said, you have to know the risk. You have to know what could and could not happen."

But the risks did not sway her.

"You either be fat for the rest of your life or you make some changes," Verhelst said.

She said she looked ahead and underwent surgery because she wanted to avoid becoming another family member with diabetes or heart disease.

"I knew if I stayed on that path I would have one or more of those problems," she said.

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