Medical Minute: Weight Loss & Bariatric Surgery- Gastric Sleeve

Nothing says Happy Sunday like talking about guts…. 

I read an article this previous week about how the Laparoscopic Sleeve Gastrectomy (Gastric Sleeve) or for the purposes of this post: GS. This procedure for weight loss is the knewest procedure on the block- essentially taking the place of the Laparoscopic Band (Lap Band). 

What the analysis being discussed in this article was looking at were 5 year outcomes of excess weight lost, improved control/remission of Type 2 Diabetes, and Hypertension being either resolved or improved.

Looking at long term data is a really big deal for these types of procedures it essentially serves as a benchmark to examine many things: complications, improvements in health, examining if there is room for improvements in the surgical technique, are there curriculum shifts that need to made to pre and post patient education. Suffice it to say long term data (5, 10, 20 years) is helpful. 

Some very quick background on the GS: this procedure is the newest standalone bariatric procedure – it was developed in 2002 to be used as an initial step for BPD/DS (Biliary Pancreatic Diversion/Duodenal Switch)- I know so many big words. I’ll cover that procedure in another post. But then surgeons realized they could just do the GS by itself.

It’s important to know that the GS is not in fact a sleeve at all- it produces weight because of gastric manipulation &  hormonal changes occur because of this promote weight loss. It gets called the sleeve because of the way the stomach is surgically cut- 80% of the fundus is removed- it makes the remainder of the stomach look like a little sleeve. 

  
The analysis was done by JAMA Surgery – researchers in Israel looked at a group of 440 adults who were operated on by the same surgical team. They looked at outcomes up to the five year mark- however, it is important to note that the researchers say they had complete data at the five year mark for only 39 patients. 

What they found:

At the first year excess weight had decreased by 77%, and this declined to only 56% at year 5.

Type 2 Diabetes had partially or completely resolved in 93% of eligible patients at 1 year, this dropped to 80% by year five

Hypertension had partially or completely resolved in 78% at year 1, this fell to 55% at year five. 

Again note that the researchers stated to only have complete data on 39 patients at the five year mark. Secondly for the type 2 diabetes note that they say “eligible patients”, diabetes remission is an elusive an magical unicorn. It is possible but not for everyone- and again remission is different than cure. The researchers did not spell out their criteria for an eligible patient but my guess is someone who has not diabetes for only a few years and does not require insulin- again this is me just taking a stab based on what I have seen. 

In closing this is really just a small snippet of data starting to examine long term outcomes of GS. Bariatric surgery is not a quick fix and should never be presented in such a way. It is a surgery like any other. What I have found in practice is- the more education, and access to education patients have to RDs, Social Workers, doctors, therapists etc both before and after this surgery is a huge help for better outcomes and continued behavior change. 

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