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Outcomes

Surgical benefits demonstrated out to three years

Both surgical groups reported a reduction in comorbidities

Severely obese patients who have a gastric bypass or laparoscopic adjustable gastric band experience substantial weight loss three years after surgery, with most of the change occurring in the first year, according to researchers from the University of Pittsburgh's School of Medicine and Graduate School of Public Health.

The study findings, published online in the Journal of the American Medical Association, also found variability in both weight change and improvements in obesity-related complications, including diabetes, hypertension and high cholesterol.

"Bariatric surgery is not a 'one size fits all' approach to weight loss," said lead researcher, Dr Anita Courcoulas, a bariatric and general surgeon at Magee-Womens Hospital of UPMC. "Our study findings are the result of data collected from a multi-centre patient population, and emphasise the heterogeneity in weight change and health outcomes for both types of bariatric surgery that we report."

Study

The researchers examined data from the Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, a multi-centre observational cohort study, encompassing ten hospitals in six geographically diverse clinical centres and a data coordinating centre, that assesses the safety and efficacy of bariatric surgical procedures performed in the US.

The researchers gathered highly standardised assessments and measures on adult study participants undergoing bariatric surgery procedures and followed them over the course of three years.

The research included 1,738 participants who underwent bypass surgery and the 610 participants who received a gastric band. The 110 participants who underwent the less commonly performed procedures in LABS-2 were not included.

In the three-year follow-up after bariatric surgery, the researchers observed substantial weight loss for both procedures, with most of the change occurring during the first year. Participants who underwent gastric bypass surgery or laparoscopic adjustable gastric banding experienced median weight loss of nearly 32 percent and 16 percent, respectively.

Additionally, of the gastric bypass surgical participants who had specific obesity-related health problems prior to surgery, 67 percent experienced partial remission from diabetes and 38 percent remission from hypertension. High cholesterol resolved in 61 percent of the participants who underwent bypass surgery.

For those who underwent laparoscopic adjustable gastric banding, 28 percent and 17 percent experienced partial remission from diabetes and remission from hypertension respectively, and high cholesterol was resolved in 27 percent of participants.

“LABS-2 data confirm in a heterogeneous population with a high degree of follow-up that RYGB and LAGB were associated with significant weight and health improvements at 3 years after surgery,” the authors conclude. “Reduction in weight and improvements in comorbid conditions with LAGB were less than reported in previous studies and not as large as those seen with RYGB. Longer-term follow-up of this cohort will determine the durability of these improvements over time and factors associated with variability in effect.”

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