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Bariatric surgery objections
Written by Medical News Feed   

CHICAGO—Bariatric surgery has become more acceptable, but additional research is needed to demonstrate to insurance companies and the public that it is the best long-term treatment for obesity, according to an editorial in the October issue of Archives of Surgery, one of the JAMA/Archives journals. The editorial, written by Edward H. Livingston, M.D., of the University of Texas Southwestern Medical Center, Dallas, is part of a theme issue on bariatric surgery.

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"The studies presented in this issue of the Archives provide us with more knowledge about these procedures’ risks, outcomes, complication profiles, improved functionality associated with surgically induced weight loss, need for long-term monitoring and equivalency of the various laparoscopic banding operations," Dr. Livingston writes. "However, we will need more to convince the non-believers in bariatric surgery that it is the appropriate therapy for morbidly obese patients who have, or may develop, complications from their excessive weight."

Papers in the theme issue suggest that:

  • Routine upper gastro-intestinal (GI) studies—expensive tests typically performed following bariatric procedures—may not be necessary
  • Current techniques for examining the upper GI in patients with abdominal symptoms can be modified to accommodate those who have had gastric bypass
  • Anastomotic leaks at the surgical site can have devastating consequences and should be treated as early as possible
  • About 4.4 percent of patients experience bowel obstructions after gastric bypass
Such ongoing research is necessary due to the lack of alternatives for obese patients, Dr. Livingston notes. "Nonsurgical weight loss efforts in the morbidly obese result in transient weight loss, if any at all," he writes. "There are no anti-obesity drugs in the pipeline that will be released soon, and even so, none of the medications in development appear to have major impact on morbid obesity. Thus, weight loss surgery is here to stay since it is the only treatment modality with proven success at inducing profound and sustained weight loss for the morbidly obese."

"This edition of the Archives goes a long way to addressing the critical issues facing this field," Dr. Livingston concludes.
(Arch Surg. 2007;142(10):919-922.

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