Studies show that the number of bariatric surgeries being performed in the U.S. continues to increase. However, these procedures’ quality and safety vary widely from one hospital to another. HealthGrades, a Golden, Colorado-based, independent healthcare ratings organization, has released the findings of its fifth annual study of bariatric surgery. For this recent study, more than 190,000 patients who had undergone bariatric surgery from 2006-2008 were involved. These patients had been discharged from 684 hospitals in 19 states.

Surgical Complications Falling Nationwide
For the purposes of the study, the researchers assigned hospitals one of three ratings, indicating “best-performing,” “average-performing” and “poor-performing” facilities. And the good news? The ratings showed that the overall rates of risk-adjusted, in-hospital complications and mortality related to obesity surgery are decreasing!

Specifically, the researchers found that those patients at top hospitals experienced a 66.55% lower chance of experiencing complications than those patients who underwent bariatric surgery at a bottom-ranked hospital. In addition, the patients at top hospitals reported shorter lengths of stay. The researchers concluded that if all bariatric patients had surgery at levels similar to top-ranked hospitals, 5,046 patients could avoid major in-hospital complications during this three-year period.

Which Facility You Choose Plays A Large Part
But there is some bad news - The researchers did observe that there were large performance gaps among the different facilities. As an example, bariatric surgery mortality, which is rare, was found to occur four times more at bottom-performing hospitals than top-performing hospitals.

“Bariatric surgery has been proven to reduce caloric intake and control obesity, but the HealthGrades study demonstrates that where patients have this type of surgery matters-a great deal,” said Rick May, HealthGrades’ vice president of clinical consulting. “There is a subset of U.S. hospitals whose patients, the data show, have fewer complications and leave the hospital earlier.”

Source: Modernhealthcare.com/article/20100526/NEWS/305259974

Greek researchers found that repeated bariatric weight loss surgeries may result in higher risks of complications than undergoing one procedure. These procedures have been shown to be the only effective method for long-term weight loss in severely obese people.

The study’s findings, which were published in the journal Archives of Surgery, focused on 56 patients who had repeat bariatric surgery between 1995 and 2008. The patients’ average age was 39.6, while the average body mass index (BMI), the measurement of weight and height, was 46.9. A BMI score of more than 30 is considered “obese.”

The Potential Risks of Multiple Bariatric Procedures
The results showed that the rates of patients having multiple (or “revisional”) bariatric surgery range from 5-56%. In the study, the patients were followed-up for an average of 102 months after their revisional surgery. It was found that while no patient died, 19 (33.9%) experienced serious complications within 1-3 months after surgery, including: internal leakage from the surgical site, acute kidney failure and pneumonia. As for late complications, which occur more than 90 days after surgery, these were reported in 13 patients (23.2%). These complications included: hernia at the incision site and narrowing of the passageway between the stomach and intestine.

For the study, 39 patients underwent revisional surgery due to inadequate weight loss after their initial procedure. These patients achieved a significant decline in BMI, declining from an average of 55.4 to 35; this represents an average loss of nearly 69% of excess body weight. In addition, these revisional procedures imparted benefits for those experiencing nutritional complications and intolerable side effects after their initial procedure. Patients are classified as having revisional bariatric surgeries for three reasons:

1. Unsatisfactory weight loss after the initial procedure
2. Severe nutritional complications such as protein malnutrition, and
3. Intolerable side effects such as blocking or narrowing of the digestive tract.

The study’s authors believe that as these procedures are continually improved, and their benefits for weight loss are publicized, revisional surgeries may become more common.

Researchers at Monash University and the Royal Children’s Hospital in Melbourne show that one specific procedure — lap-band surgery — may lead to a loss of up to 80% of excess fat in patients!  In fact, the surgery’s outcomes, which were published in the Journal of the American Medical Association, were shown to be much more effective for adolescents than just following severe dieting and exercise programs.

The Lap-Band Vs. “Lifestyle” Changes
For the government-funded study, the researchers observed 50 severely obese teens between the ages of 14 and 18 from May 2005 to September 2008. Half of the patients underwent gastric banding surgery, in which a silicon clamp is implanted that shrinks the stomach and reduces appetite. These patients were told to eat only three small meals and exercise for 30 minutes each day. Meanwhile, the other 25 patients remained on a strictly supervised diet and exercise regime.

It was found that those receiving the surgery lost an average of 77 pounds, which was more than 10 times the weight of the other group. Overall, after two years, those teens undergoing surgery lost an average of 79% of their excess weight, while those following just the lifestyle changes lost just 13%. It should be mentioned that six of the lifestyle group withdrew from the study after gaining weight, even though they had access to a personal trainer, physician, dietician and regular guidance.

Weight Loss Benefits, But NOT A “Quick Fix”
The bottom line? Lap-band weight loss surgery may offer remarkable benefits for weight loss for teenage patients. “While this study confirms that some adolescents can achieve substantial weight loss and health improvements through diet and exercise, gastric banding should be considered for those severely obese adolescents who find primary weight loss methods unsuccessful,” stated study author Professor Paul O’Brien.

However, healthcare professionals caution that this and other procedures are not a “quick-fix” solution for weight loss, especially for younger patients.

In a study published in the Journal of the American College of Surgeons, New York University researchers focused on about 50 girls and boys ages 14-17. The findings of the study revealed that the subjects demonstrated significant decreases in both total and “android fat” mass 2 years after surgery. “Android fat,” or abdominal obesity, has been associated with the development of obesity-related illnesses, including diabetes, heart disease, and insulin resistance.

Benefits for Weight Loss & Overall health
The researchers found that undergoing Lap band surgery effectively improved glucose metabolism. In turn, this then reduced the teenage subjects’ risks for developing insulin resistance. The researchers also found that as the surgery had no impact on bone mineral density, bone growth was not affected.

“This study is the first to demonstrate the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents,” said Evan Nadler, MD, the lead author. “While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications.”

SOURCE: Laparoscopic Adjustable Gastric Banding for Morbidly Obese Adolescents Affects Android Fat Loss, Resolution of Comorbidities, and Improved Metabolic Status. Journal of the American College of Surgeons, 2009; 209 (5): 638 DOI: 10.1016/j.jamcollsurg.2009.07.022

Being overweight or obese is difficult enough for adults, but for children and adolescents, it can be especially harmful, both for now and in years to come. However, new research offers hope that one type of surgery, laparoscopic adjustable gastric banding (Lap band), may greatly improve the health of teenagers struggling with morbid obesity.

In a study published in the Journal of the American College of Surgeons, New York University researchers focused on about 50 girls and boys ages 14-17. The findings of the study revealed that the subjects demonstrated significant decreases in both total and “android fat” mass 2 years after surgery. “Android fat,” or abdominal obesity, has been associated with the development of obesity-related illnesses, including diabetes, heart disease, and insulin resistance.

Benefits for Weight Loss & Overall Health
The researchers found that undergoing Lap band surgery effectively improved glucose metabolism. In turn, this then reduced the teenage subjects’ risks for developing insulin resistance. The researchers also found that as the surgery had no impact on bone mineral density, bone growth was not affected.

“This study is the first to demonstrate the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents,” said Evan Nadler, MD, the lead author. “While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications.”

SOURCE: Laparoscopic Adjustable Gastric Banding for Morbidly Obese Adolescents Affects Android Fat Loss, Resolution of Comorbidities, and Improved Metabolic Status. Journal of the American College of Surgeons, 2009; 209 (5): 638 DOI: 10.1016/j.jamcollsurg.2009.07.022

Metabolic syndrome is actually a group of conditions associated with increased risks of other harmful conditions, including stroke, diabetes and cardiovascular problems. As a new study published in the Mayo Clinic Proceedings illustrates, gastric bypass surgery has been shown to cure this disease in extremely obese people.

In this 13-year study (from 1990-2003), the evaluated patients included 180 who had already had bypass surgery, and 157 patients who did not undergo the procedure. For the involved patients, the average body mass index (BMI) for the surgical group was 49, while the average for the nonsurgical group was 44. Normal BMI scores range from 18.5- 24.9. The study’s patients had to meet at least three of five criteria:

• High levels of triglycerides, which are “bad” fats
• Low levels of high-density lipoprotein, which is the “good” cholesterol
• Increased blood pressure levels
• High blood sugar levels
• Obesity

Exploring the Study’s Findings
During an average follow-up of 3.4 years, it was shown that the prevalence of metabolic syndrome decreased from 87-29% in the surgical group, and 85-75% in the control (nonsurgical) group. The average weight loss was 44 lbs in the surgical group and 0.2 lbs in the nonsurgical group.

The researchers stressed that the key to fighting this condition was losing weight. “Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients,” stated Dr. Francisco Lopez-Jimenez, the lead researcher. They researchers went on to say that “gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures” in those eligible for surgery.
http://www.reuters.com/article/healthNews/idUSCOL55839920080825?feedType=RSS&feedName=healthNews

Known as the endoluminal pouch reduction, this non-invasive technique is basically an interior corset. Medical professionals and obesity experts alike hope that this procedure will enable people to lose weight gained back after undergoing traditional stomach-reducing surgery.

With this procedure, bariatric surgeons descend a unique flexible device that includes a camera down patients’ throats to their stomachs. Once there, this device sucks up stomach portions. Then, this device fasten these portions down, forming a circular pattern of pleats. Essentially, this forms a corset; one requiring no surgical incisions and more importantly, a reduced time period in the hospital and for recovery.

While this procedure has demonstrated valuable benefits for patients, it’s only performed on 10-20% of patients. This is because many patients who have undergone bariatric surgery have stretched out their stomachs. This surgical side effect does not affect all recipients; why some are affected and some aren’t is itself a mystery.

However, for those who do qualify for the endoluminal pouch reduction, the procedure may offer the rare opportunity for a surgical “do-over.” Typically, having a second stomach stapling places the patient at risk for a 12-20% risk of bleeding and leakage; there’s a one-5% risk of bleeding and leakage during initial stomach stapling procedures.
http://www.canada.com/Health/Canada+first+stomach+corset+procedure+help+obesity/1327574/story.html

According to a study published in the Journal of the Society of Laparoendoscopic Surgeons (JSLS), patients may qualify for a revolutionary, quick AND effective weight loss procedure, performed on an outpatient basis. Surgeons and their teams are now offering minimally invasive adjustable gastric banding and gastric bypass surgeries, which are completed in less than two hours.

A Life-Saving Alternative for Patients
Healthcare professionals believe that this fast turnaround could not have come at a better time. Recent estimates show that the ever-growing obesity epidemic has skyrocketed. About 205,000 individuals underwent  bariatric surgery in 2005, compared to 1992’s 16,200 procedures.

Typically, these procedures – most often, either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB) – were performed in a hospital setting. But in an effort to drive more patients to having surgery, researchers sought out alternatives, especially that of ambulatory surgery centers (ASCs). Over the course of a six-year study (2002-2008), the researchers examined these facilities’ safety and effectiveness for these bariatric procedures. They performed a total of 248 weight loss surgical procedures (210 LAGB and 38 LRYGB procedures).

The findings showed that these facilities were as effective and safe as hospital settings. Those patients undergoing LRYGB procedures had an average body mass index (BMI) score of 44.7, while the average for those undergoing LAGB procedures was 43.79. However, 12 months after the procedures these BMI scores dropped an average of 69.62% and 32.58%, respectively. Meanwhile, the typical amount of time for the procedures was 112.80 minutes (for LRYGB surgery) and 72.10 minutes (for LAGB surgery).

“This marks a turning point in the battle against obesity, by shifting life-changing weight-loss surgery to the outpatient arena with minimally invasive surgery,” says lead author, Kent Sasse, M.D., M.P.H., FACS. “This study further validates the hypothesis that an overweight person can safely undergo weight-loss surgery in about two hours, at an outpatient surgical facility, return home later the same day, take very little time off, and lose a large amount of weight.”

It has been revealed that prior to undergoing weight loss procedures such as lap band surgery, or gastric banding surgery, the typical patient has tried their luck with an average of 24 diets and exercise regiments. These findings were spotlighted at the most recent annual meeting of the American Society for Metabolic and Bariatric Surgery.

Bariatric Procedures May Hold the Key to Success
The researchers focused on 409 bariatric surgery patients; these included those men and women who had undergone either gastric bypass or adjustable gastric banding procedures. It was shown that the majority were usually 100 or more pounds overweight before surgery. These patients also suffered from an average of five obesity-related conditions, including: type 2 diabetes, high blood pressure and/or sleep apnea.

The researchers noted that for those patients who most closely followed the advised post-surgical recommendations, an average of 123 pounds were lost during the first year. Those who didn’t follow the guidelines as closely typically lost about 92 pounds. At the five-year mark, the more diligent patients lost over 127 pounds, while the less responsible lost 100 pounds. According to healthcare and weight loss surgery professionals, the level of compliance is the “the difference between a good result and a great result.”

While every surgery team and patients may have unique guidelines to follow, there are certain points to consider. These post-surgical guidelines include: recommendations for regular exercise; changes to eating habits; receiving nutritional counseling and psychological support, and attending patient support groups; keeping a food diary; and visiting surgeons and/or doctors regularly. Estimates show that for 2007, about 205,000 people had bariatric surgery.

According to a study published in the Journal of Clinical Endocrinology and Metabolism, it was shown that after weight loss surgery, patients are more likely to lose bone density. The researchers also noted that the greater the weight lost, the greater the bone density lost.

Exploring the Bone Density Study’s Findings

In the study, the researchers focused on 23 men and women who had undergone a popular weight loss procedure, Roux-en-Y gastric bypass surgery. With this procedure, the surgeons are able to avoid part of the small intestine known as the duodenum; this is the body’s main site of calcium absorption.

• Pre-surgery, the patients’ vitamin D blood levels were found to be less than ideal, although nutrient intake was considered high.
• Post-surgery, it was found that the patients doubled their calcium intake, and consumed 2.6 times more vitamin D. Additionally, their vitamin D blood levels remained low, and their calcium blood levels decreased.
• Within three months after surgery, they expressed signs of poor calcium absorption. Before undergoing surgery, the patients’ levels of parathyroid hormone — responsible for the bones’ release of calcium — had been in the high normal range; post-surgery, these levels actually increased.
• One year after surgery, the patients lost an average of 99 pounds. As for their levels of bone density, their upper thigh bones’ density had lost 9.2%, and their hip bone density fell 8%. Most of the subjects showed no loss of bone density in their lower backs or forearms.

It’s thought that the decreased bone density may be due to the fact that as heavy amounts of weight are lost, the bones bear much less weight. However, weight-bearing is considered a leading component in the maintenance and structure of bone strength. The higher secretion of parathyroid hormone levels may also contribute to these lower bone density levels.

Following bariatric surgery, patients are left with a smaller area in their gut to absorb nutrients from their food. Researchers theorize that these procedures may be harmful to bone and mineral metabolism. The association between decreased bone density and future fractures was unclear. Nevertheless, medical professionals advise bariatric patients to stay alert for nutritional deficiencies and bone loss, both before and after their procedures.