Slimming surgery increases fivefold in 5 years, and is lowering mortality

December 13, 2007

The worldwide obesity epidemic has increased the number of bariatric (slimming) surgical procedures more than fivefold within five years in most developed countries; there is also mounting evidence that the surgery reduces mortality in morbidly obese patients. The issues surrounding this controversial method for weight management are explored in a Clinical Update in this week's edition of The Lancet.

Dr Michael Korenkov, Department of Abdominal Surgery, University of Mainz, Germany, and Dr Stefan Sauerland, Institute for Research in Operative Medicine, University of Witten/Herdecke, Germany, authored the Clinical Update, and in it refer to two recent studies which showed bariatric surgery reduced mortality in morbidly obese patients by 29% and 40% respectively.

They examine the two divisions of bariatric procedure - gastric restrictive, which reduce food intake; and malabsorption, those that reduce food uptake from the digestive tract. The different types of operation available within each division are discussed in detail, with the authors commenting that the choice of surgical procedure "partly depends on the repertoire of the surgeon." Different types of operation are more or less common depending on the world region.

Of course, the effectiveness of obesity surgery has been traditionally measured only in terms of excess weight loss - for which data clearly indicate the effectiveness of all procedures. The authors say: "Today, research emphasis is more on the effect of surgery on obesity-related comorbidities, which can affect metabolic, cardiovascular, respiratory, gastrointestinal, musculoskeletal and urological organ systems. Additionally, the psychological benefits of weight loss are being investigated. New data indicate that at least some bariatric procedures exert their beneficial metabolic effects not only by weight loss but also through a change in hormone release from the gut. This finding corresponds to clinical observations that obesity in patients with diabetes is especially amenable to bariatric surgery."

The authors feel that as with other surgical disciplines, expertise of the surgical team is crucial in determining outcome, and call for knowledge and skills to be concentrated in bariatric surgery centres. They say: "Mortality in high-volume centres is lower than in lower-volume centres."

They conclude: "In summary, there is good evidence to show that bariatric surgery is more effective than non-surgical approaches in the therapy of morbid obesity. However, no single operation is ideal for every morbidly obese patient, and all operations also entail some disadvantages."
-end-
The paper associated with this release is at http://multimedia.thelancet.com/pdf/press/Slimming.pdf

Dr Michael Korenkov, Department of Abdominal Surgery, University of Mainz, Germany T) +49-6131-172775 / +49-6131-2063 E) korenkov@ach.klinik.uni-mainz.de

Lancet

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