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14 Year Obesity Study

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14 Year Obesity Study

This information is a combination of first hand data and information cleaved from other creditable sources found through research on the World Wide Web. Credits and citations are at the end of this document:

The abstract from the 14 year study is given below along with other listings that contains interesting references.

About the "Intestinal Bypass" -- in most or all of those procedures there were NO surgical changes in the stomach. The idea that the "intestinal bypass" was derived from is: "...it doesn't matter how much you eat, only how much your body absorbs." It is okay, and in fact necessary, for most people who have had an "intestinal bypass" to eat a high volume of food because their intestines have been shortened a great deal -- in most of these procedures different percentages of the small intestine has been either bypassed or removed. The amount of food that an "intestinal bypass" person can eat should not be compared with the amount of food that a person with a "gastric bypass" can eat. The surgeries are completely different.

Interestingly, there are surgeons doing "Gastric Bypasses" who are also bypassing portions of the small intestine. Dr. George Cowan, Jr. is one of the Pioneers in this field where great success is being achieved with a combination of "Gastric Bypass" and the "Intestinal Bypass." The size of the gastroplasty is varied by individual needs as is the length of small intestine that is bypassed. The average to be compared with is a 1ounce stomach pouch and 65 % intestinal bypass (bypassing all of the duodenum and jejunum, and a large portion of the ileum).

It's also not necessarily a good idea to compare the food intake of a person with a proximal bypass to the food intake of people who have had "some amount" of distal procedure. For example, the stomach size of most people who have had a bilio-pancreatic diversion (that is a distal procedure that preserves the pyloric valve hence no dumping, but with significant malabsorption from the distal bypass) have a much larger pouch than a person with the typical "Proximal RNY." In the study cited below the average pouch size is 30 cc.

Something to remember about stomach pouches and eating is that because there is no pyloric valve (with an RNY) that food begins to empty from the pouch fairly soon. The rate at which the pouch empties is related to the size of the anastomosis (the opening to the intestine). A person with a large anastomosis may believe, incorrectly, that his/her pouch has stretched because if they eat slowly enough they can eat a large portion of food.

Title: Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.

Author: Pories WJ; Swanson MS; MacDonald KG; Long SB; Morris PG; Brown BM; Barakat HA; deRamon RA; Israel G; Dolezal JM; et al

Address: Department of Surgery, School of Medicine, East Carolina University, Greenville, North Carolina, USA.

Source: Ann Surg, 1995 Sep, 222:3, 339-50; discussion 350-2

Abstract:

OBJECTIVE: This report documents that the gastric bypass operation provides long-term control for obesity and diabetes.

SUMMARY BACKGROUND DATA: Obesity and diabetes, both notoriously resistant to medical therapy, continue to be two of our most common and serious diseases.

METHODS: Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mL, (2) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of the patients were seriously ill, the operation was performed with a perioperative mortality and complication rate of 1.5% and 8.5%, respectively. Seventeen of the 608 patients (< 3%) were lost to follow-up.

RESULTS: Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (range, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 to 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years. The operation provides long-term control of non-insulin-dependent diabetes mellitus (NIDDM). In those patients with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in caloric intake, suggesting that insulin resistance is a secondary protective effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a number of other comorbidities of obesity, including hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility. Gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities.No other therapy has produced such durable and complete control of diabetes mellitus.

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Subject: Journal Articles, mortality, etc.

In answer to requests for sources of information, it is a good suggestion to investigate the following papers and web sites.

The ASBS web site and their discussion of rational for surgery. They cite the ongoing Swedish Obesity Study that, 6 years into the study, shows for each (1) surgery person who has died, 9 obese people who didn't get surgery have died. A nine-fold decrease in mortality after surgery.

Also recommended is the Benotti and Forse review article published in the American Journal of Surgery, 1995, vol 169, pages 361-7 for an exhaustive list of articles about all aspects of Bariatric Surgery. There is information in this review concerning the greater weight loss associated with RNYs in comparison with VBGs, as well as better success in keeping the weight off over longer periods of time.

Another paper of interest is Pories, Swanson, MacDonald, et al, Ann Surg., September 1995 pages 339 - 352. This paper is about the reversal of diabetes mellitus which occurs in roughly 83% of the non-insulin dependent diabetics who have RNYs. Included in this paper is the information that the mortality rate among patients in the control group, who had not had surgery, was 4.5 times greater than that of the surgical group. Resultant 22 deaths out of 72 people who didn't have the surgery and 14 deaths out of 154 people in the surgery group (this is over a 14 year period). If the mortality rate in the surgical group had been as high as that of the nonsurgical group then somewhere between 46 and 58 people in the surgical group would have died.

Abstracts are free and papers may be purchased from Medline. http://www.healthgate.com


Mortality Rates:

The American Society for Bariatric Surgery reports the operative mortality rate reported is 0.17% within 30 days of the operation. This article and other important information can be seen at their web site: www.asbs.org

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