Americans' bulging waistlines have created a huge demand for gastric bypass surgery; the number of these procedures has increased by more than 600 percent in the past decade. For the morbidly obese, this operation can literally be a lifesaver. But, it can also be risky, and finding a good surgeon is important. New research from Tufts-New England Medical Center suggests you might want to look for a doctor with some experience under his belt.
What the researchers wanted to know: Does doing more gastric bypass surgery give a doctor better results?
What they did: The researchers looked at the records from 750 patients who had a common and often recommended type of gastric bypass surgery called laparoscopic Roux-en-Y gastric bypass between March 1998 and April 2004 in the same obesity center at Tufts. In the first year of the study, the doctors performed only 16 laparoscopic Roux-en-Y gastric bypass surgeries; now they perform more than 400 per year. The researchers looked at whether the patients who had surgery more recently fared better than those first few.
What they found: The results of the first 100 patients were not as good as those after them. Out of the first 100 patients, 26 had complications and one died. For the next 650 patients, 13 percent had complications and the mortality rate dropped to 0.3 percent. Specific complications also dropped after the first hundred patients: Wound infection decreased from 8 percent to 2 percent and bowel obstruction went from 5 percent to zero. In addition, the average time that it took to perform the surgery dropped from 212 minutes for the first hundred patients to 132 minutes for the second group. For the final hundred patients in the study the operation took anywhere between 65 and 200 minutes.
What it means to you: There are many things you should consider before undergoing gastric bypass surgery, and choosing a doctor is one of the most important. As these researchers point out, laparoscopic Roux-en-Y gastric bypass surgery is considered a technically difficult surgery, and it may take surgeons a while to master it. As this study and others have suggested, going to a center that performs a lot of this type of surgery could give you a better result.
Caveats: Over the six years of the study, the surgical techniques improved slightly, which could have made the surgeries easier for those later patients regardless of their surgeon's skill. In addition, several doctors who commented on this study in the journal wondered whether residents or fellows, who stay in the hospital for only a short time, performed surgeries throughout the study, meaning that the same doctors were not doing surgeries for the entire six years. The lead author, however, said that when new surgeons came into the operating room, they were closely monitored by doctors who had done many gastric surgeries.
Find out more: The National Institute of Diabetes and Digestive and Kidney Diseases has a website that clearly describes the different types of gastric surgery.
The Columbia University Department of Surgery also has a good description of both gastric surgery in general and Roux-en-Y surgery.
The Cleveland Clinic has a page with some things to think about if you're considering gastric bypass.
Read the article: Shikora, S.A. et al. "Laparoscopic Roux-en-Y Gastric Bypass." Archives of Surgery. Vol. 140, No. 4, pp. 362-367.
Abstract online: http://archsurg.ama-assn.org