Sleeve gastrectomy, a procedure where surgeons remove about 80 percent of the stomach, has become the most popular method of weight-loss surgery in America, surpassing laparoscopic gastric bypass, which had been the most common procedure for decades, according to researchers from Cleveland Clinic.
The findings were presented here at ObesityWeek 2015, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The weeklong conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).
Researchers studied nearly 72,000 patients who had bariatric surgery between the years 2010 and 2013. In 2010, sleeve gastrectomy accounted for just 9.3 percent of procedures, while 58.4 percent were laparoscopic gastric bypass and 28.8 percent were gastric band procedures. By 2013, nearly half (49%) the procedures were sleeve gastrectomy, 43.8 percent were gastric bypass, and the number of gastric band procedures had plummeted to just 6 percent.
"We've seen a real shift in the world of bariatric surgery with the emergence of the sleeve gastrectomy," said Philip Schauer, MD, a study co-author and director of the Cleveland Clinic Bariatric and Metabolic Institute in Ohio. "In just four years, there's been a five-fold increase in the number of these operations. This is likely due to a combination of factors including better insurance coverage and more data demonstrating its safety and effectiveness in treating obesity and related diseases."
For the study, the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database was analyzed to identify adult patients with a body mass index (BMI) of 35 or more who had some form of bariatric surgery. Patients were predominantly female (78.1%) and about 45-years-old.
During the four years covered in the study, there were no significant changes in age or gender in terms of overall operations, but the proportion of women undergoing sleeve gastrectomy increased to 79.2 percent from 73.2 percent, and the average BMI dropped from 47.8 percent to 45.9 percent. The number of patients with a BMI of 50 or more decreased (23.6% to 32%), as did the number of patients with hypertension (56.2% to 48.4%).
Gastric bypass appears to be the most popular operation among those with type 2 diabetes, rising to 33.3 percent from 30.4 percent. At the same time, patients with diabetes having sleeve gastrectomy dropped from 26.6 percent to 22.5 percent.
"Each of the bariatric operations has a place in the treatment of obesity and related diseases," said John M. Morton, MD, MPH, president of the ASMBS and Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. "The answer as to which one is right for which patient is based on a careful evaluation of the risks and benefits of each procedure and the health status of the patient," added Dr. Morton, who was not involved in the study.
According to the ASMBS, about 193,000 people had bariatric surgery in 2014, and by its own estimates, sleeve gastrectomy was also found to be the most common procedure, accounting for 51.7 percent of weight-loss operations, followed by gastric bypass (26.8%), gastric band (9.5%), and biliopancreatic diversion with duodenal switch (0.4%).
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