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Results of Bariatric Surgery Hold Up Over Time

Results of Bariatric Surgery Hold Up Over Time

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Action Points

  • Long-term benefits of bariatric surgery — Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding — persisted for years.
  • Several comorbid conditions improved from baseline through 7-years post-surgery for the RYGB group, including prevalence of hypertension, high LDL cholesterol, high triglycerides, and low HDL cholesterol.

Long-term benefits of bariatric surgery persisted for years, according to results from a longitudinal study.

People who underwent Roux-en-Y gastric bypass (RYBG) sustained a mean weight loss of 38.2 kg or 84.2 lbs (95% CI 36.9-39.5) 7 years after undergoing surgery, for a mean reduction of 28.4% of baseline weight (95% CI 27.6-29.2), reported Anita P. Courcoulas MD, MPH, of the University of Pittsburgh Medical Center, and colleagues.

Similar findings were seen among those who underwent laparoscopic adjustable gastric banding (LAGB), with an average weight loss of 18.8 kg or 41.4 lbs (95% CI 16.3-21.3) after 7 years, for a mean baseline weight reduction of 14.9% (95% CI 13.1-16.7), they wrote in JAMA Surgery.

“One of the main goals of the study was to understand the longer-term effectiveness of bariatric surgical procedures,” Courcoulas told MedPage Today in an email. “An important strength of this study is that the data was standardized and prospectively collected with high follow up rates, especially for weight change.”

“This particular study addresses the durability and variability of weight loss, and also the prevalence, remission, and incidence of several health conditions; diabetes, abnormal lipids/cholesterol, and hypertension/high blood pressure,” she added.

A total of 2,348 individuals — 1,738 who underwent RYBG and 610 underwent LAGB — recruited from 10 geographically diverse U.S. hospitals, were included in the Longitudinal Assessment of Bariatric Surgery (LABS). The participants were followed up annually after presurgical and 6-month assessments.

The majority of participants showed a slight regain in weight between 3 to 7 years after surgery, although this remained relatively low for both surgery groups. Among those who underwent RYBG, there was an average of 3.9% of baseline weight regain during post-surgical years 3 through 7 (95% CI 3.4-4.4). During this time frame, LAGB patients reported a mean 1.4% baseline weight regain (95% CI 0.4-2.4).

Long-term benefits of bariatric surgery were not limited solely to weight loss, however. Among the 488 RYGB patients who had diabetes at the time of surgery, the majority not only achieved remission, but also maintained remission over the 7-year follow-up:

  • 1-year post-surgery: 71.2% achieved remission (95% CI 67.0-75.4)
  • 3-years post-surgery: 69.4% (65.0-73.8)
  • 5-years post-surgery: 64.6% (60.0-69.2)
  • 7-years post-surgery: 60.2% (54.7-65.6)

A substantial portion of the 175 LAGB patients who had diabetes at baseline also were able to achieve and sustain remission:

  • 1-year post-surgery: 30.7% achieved remission (95% CI 22.8-38.7)
  • 3-years post-surgery: 29.3% (21.6-37.1)
  • 5-years post-surgery: 29.2% (21.0-37.4)
  • 7-years post-surgery: 20.3% (9.7-30.9)

“These findings are not particularly surprising, but they do confirm, in a prospective and very carefully studied group of over 2,000 people, that the weight lost after bariatric surgery is quite variable, yet most people keep the majority of the weight off at the longer-term 7 year follow-up time-frame that we studied,” Courcoulas highlighted.

Several comorbid conditions improved from baseline through 7-years post-surgery for the RYGB group, including prevalence of hypertension (51.6 at 7-year follow-up] versus 67.6 at baseline), high LDL cholesterol (14.3 versus 33.3), high triglycerides (4.9 versus 23.7), and low HDL cholesterol (5.8 versus 34.9. P<0.001 for all).

For the LAGB group, prevalence of those with low HDL cholesterol and high triglycerides also improved 7 years after surgery (16.3 versus 33.0 and 9.7 versus 21.3, respectively, P<0.001 for both).

In an accompanying commentary, Kelvin D. Higa, MD, of the University of California San Francisco in Fresno, and Jacques Himpens, MD, PhD, of the European School of Laparoscopic Surgery in Brussels, stated that the researchers “must be commended for their meticulous and valuable work that underscores the benefits of Roux-en-Y gastric bypass and adjustable gastric banding in terms of weight loss and adiposity based chronic diseases.”

However, they pointed out that participant retention was underwhelming, with only 57% of patient data available at the 7-year follow-up. Additionally, Higa and Himpens highlighted the absence of sleeve gastrectomy data from the study, mainly due to the timing of patients recruitment occurring between 2006-2009. “We must relentlessly and actively search for the potential harmful and even very long-term adverse effects of the procedures we perform every day,” they urged.

“The longer-term follow-up of LABS participants ended at the 7-year time point, but other research questions have been and will be addressed with the data collected in LABS,” Courcoulas told MedPage Today.

Click here for the American Association of Clinical Endocrinologists’ clinical practice guidelines for the care of the bariatric surgery patient.

The study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

Courcoulas disclosed support from Covidien/Ethicon J&J. Co-authors disclosed relevant relationships with Pacira Pharm, the Patient Centered Outcomes Research Institute, Covidien, Ethicon, Medtronic, WL Gore & Associates, Johnson & Johnson, Nestle Corp, and Novo Nordisk.

Higa and Himpens disclosed no relevant relationships with industry.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2017-12-06T11:00:00-0500

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