The "Con" argument for bariatric surgery

THE CONS OF BARIATRIC SURGERY

By Anna Yancey

Bariatric Surgery Overview

There are 3 basic concepts for bariatric surgery (Saber, 2013) Gastric restriction (lapband) Gastric restriction with mild malabsorption

(gastric bypass) A combination of mild gastric restriction

and malabsorption (duodenal switch) All are medical procedures used for

weight loss

Gastric Restriction (lap-band)

Reduces the size of the stomach by using an adjustable band. (fda.gov)

Gastric Restriction Complications

Regurgitation of ingested food Slip of the ring Gastric erosion Local pain Infection of the fluid inside the ring Dilation of subcutaneous capsule Lack of absorption of nutrients

Gastric Restriction Complications

Nearly 50 percent of patients required removal of their bands (Mercola, 2012)

60 percent needed to undergo additional surgery (Mercola, 2012)

One American clinical study that included a 3-year follow-up reported a staggering 88 percent of gastric banding patients experienced one or more adverse events, ranging from mild to severe. (Mercola, 2012)

Gastric restriction with mild malabsorption (bypass)

The size of the stomach is reduced by almost 90% and is directly connected to the middle part of the small intestine

Shortens the path of the food so less of it is absorbed

Gastric Bypass

(San Diego, Gastric bypass)

Gastric bypass complications

Anastomatic leakage Anastomatic stricture Ulceration of anastomosis Gastric dumpling syndrome Lack of absorption of nutrients

Combination of gastric restriction and malabsorption (duodenal switch)

More than 85% of the stomach is removed and by passes most of the length of the intestines, minimizing food absorption.

Duodenal Switch

(LAPSF, 2013)

Duodenal switch complications

Chronic diarrhea Anemia, protein deficiency Osteoporosis Abdominal pain

Post-Operative Diet

Clear liquids (1-2 days) Full liquid (2-3 weeks) Soft food (4 weeks-few months) Solid foods

(Isom, 2012)

Bariatric Surgery Statistics

About 20 percent of people who opt for weight-loss surgery require further procedures for complications (Klein, 2013)

30 percent deal with complications relating to malnutrition, like anemia or osteoporosis, since the intestines are absorbing fewer nutrients. (Klein, 2013)

Bariatric Surgery Statistics

As many as 20 percent of people will gain a significant amount of weight back (Klein, 2013)

Weight regain might be related to technical failures of the surgery and should be reassessed by the bariatric surgeon (Birch, Christiansen, Cottreau, Karmali, Sharma, Stadnyk & Stokfossa, 2010)

Cost of Bariatric Surgery

Cost varies between clinic and surgeons

Follow ups are routinely scheduled

Surgeon visits are scheduled every month for LAGB patients for band fills and every 3 months RYGB and LSG patients (Birch, Christiansen, Cottreau, Karmali, Sharma, Stadnyk & Stokfossa, 2010)

Costs of Bariatric Surgery

From 2004-2005 the cost of a laparoscopic pre-surgery was $1,591.86

Time of surgery was $14,468.50 Total = $16,060.36 with healthcare only

paying 14% on average. $13,811.90 is out of pocket

(Buchwald, Buessing, Cremieux, Ghosh, Shikora & Yang, 2008)

Costs of Bariatric Surgery

Open pre-surgery cost 2004-2005 was $2,246.30

Time of surgery $19,900.61 Total $22,146.91 with healthcare

paying 14% on average. $19,046.34 out of pocket

(Buchwald, Buessing, Cremieux, Ghosh, Shikora & Yang, 2008)

Post Surgery Costs

Laparoscopic costs 1-2 months after surgery $859.40

Open surgery costs 1-2 months after surgery $1,881.62

(Buchwald, Buessing, Cremieux, Ghosh, Shikora & Yang, 2008)

Conclusion

Multiple post-op complications Diet restrictions Residual weight gain Not-cost effective

Healthcare/Insurance

Works Cited

Saber, A. (2013). Bariatric surgery. Retrieved from http:/emedicine.medscape.com/article/197081-overview.

(2013, September 6). LAP-BAND® Adjustable Gastric Banding System [Web Graphic]. Retrieved from http:/www.fda.gov.medicaldevicesproductsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm248133.htm

Mercola, J. (2012, November 17). Why weight loss surgery is not a sound treatment choice for type 2 diabetes. Retrieved from http://articles.mercola.com/sites/articles/archive/2012/11/17/weight-loss-surgery.aspx

Works Cited

(2013). Vertical gastrectomy with duodenal switch [Web Graphic]. Retrieved from https://www.lapsf.com/duodenal-switch-weight-loss-surgery.php

San Diego, U. (Designer). (2010). Gastric bypass [Web Graphic]. Retrieved from http://health.ucsd.edu/specialties/surgery/bariatric/weight-loss-surgery/Pages/comparison-chart.aspx

Klein, S. (2013, January 09). Weight loss surgery side effects: Procedure's not-so-glamorous side highlighted by al roker's embarrassing story. Huffington Post. Retrieved from http://www.huffingtonpost.com/2013/01/09/weight-loss-surgery-side-effects-al-roker_n_2441223.html

Birch, D., Christiansen, S., Cottreau, D., Karmali, S., Sharma, A., Stadnyk, J., & Stokfossa, C. (2010). Bariatric surgery: a primer. Manuscript submitted for publication, College of Family Physicians of Canada, , Available from Ebscohost. (0008305X).

Works Cited

Buchwald, H., Buessing, M., Cremieux, P., Ghosh, A., Shikora, S., & Yang, H. (2008). A study on the economic impact of bariatric surgery. The American Journal of Managed Care, 14(9), doi: Ebscohost

Isom, K. (2012). Standardizing the evolution of the postoperative bariatric diet. Diabetes Spectrum, 25(4), 222-228. Retrieved from http://search.proquest.com.ulm.idm.oclc.org/docview/1237613913