Study: Bariatric surgery safe, effective but could be improved

WASHINGTON, A newer form of weight loss surgery that reduces the size of the stomach by about 75 percent was found to be safe and have a low rate of morbidity, according to new research by the American College of Surgeons.

While laparoscopic sleeve gastrectomy is relatively safe and effective for weight loss, a new study suggests it could be even safer with minor changes to surgical techniques. Photo by Apples Eyes Studio/Shutterstock

Laparoscopic sleeve gastrectomy is significantly safe, but slight changes to how doctors perform the procedure could make it even safer, according to the new study,published in the journal Annals of Surgery.

 LSG accounts for about 42 percent of bariatric surgeries, helping obese patients lose up to 70 percent of excess weight in the year after surgery.
 Multiple studies have shown the procedure to be safe and effective, but researchers at ACS decided to use a new database of bariatric surgery outcomes to examine the outcome of several different techniques.

“I think this study is important because it gets at the issue of evaluating process measures in surgery and how very important that issue is,” Dr. Elizabeth Berger, a general surgery resident at Loyola University Chicago Stritch School of Medicine, said in a press release.

For the study, the researchers looked at outcomes of 189,477 surgeries performed by 1,634 surgeons between 2012 and 2014. They looked specifically at staple-line reinforcement, oversewing versus stapling alone, bougie size and stapling distance from the pylorus.

About 80 percent of surgeons use staple-line reinforcement — a layer of material sandwiched between the staples — but the procedure carries a significantly higher leak rate and is much more expensive.

Larger sizes of bougie, a tube used to measure where the stomach is divided, had lower leak rates and larger bougies were linked to patients losing more weight within a year of surgery. Stapling done farther from the pylorus, the opening between the stomach and small intestine, was also linked to greater weight loss.

While larger bougies and stapling farther from the pylorus led to greater loss of weight, which surprised the researchers, they say the most important result of the study is the finding on staple-line reinforcement.

“It is paramount that as professionals, we remain introspective about the work we do and strive to always improve for our patients,” said Dr. Matthew Hunter, a surgeon at Massachusetts General Hospital and a senior author of the new study. “While the devil is in the details, this study elucidates some things we can potentially do to get even better results.”

By Stephen Feller