Obesity surgery results depending on technique performed: long-term outcome

Area of Science:

• Bariatric Surgery
• Obesity Treatment
• Surgical Outcomes

Background:

• Long-term efficacy of bariatric surgery techniques requires analysis beyond 2 years.
• Weight regain and late complications are concerns with some procedures.
• Evaluating weight loss, morbidity, and mortality over 5 years is crucial.

Purpose of the Study:

• To analyze the long-term (5+ years) weight loss, morbidity, and mortality of bariatric surgical procedures.
• Compare the long-term effectiveness of vertical banded gastroplasty (VBG), biliopancreatic diversion (BPD), and laparoscopic Roux-en-Y gastric bypass (LRYGBP).

Main Methods:

• Retrospective cohort study of morbidly obese patients.
• Analysis of weight loss, morbidity, and mortality using the Bariatric Analysis And Reporting Outcome System (BAROS).
• Procedures included open VBG, open Scopinaro BPD, open modified BPD, and LRYGBP.

Main Results:

• Biliopancreatic diversion (BPD) groups maintained excellent weight results long-term, unlike VBG and LRYGBP which showed weight regain.
• Mortality rates: VBG 1.6%, BPD 1.2%, LRYGBP 0%.
• Late morbidities included protein malnutrition (up to 11% in Scopinaro BPD) and iron deficiency (up to 62% in Scopinaro BPD). Revision surgeries were required for VBG (14.5%), Scopinaro BPD (3.2%), and LRYGBP (0.8%).

Conclusions:

• More complex bariatric procedures (BPD) increase effectiveness but also morbidity/mortality.
• Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is safe and effective for morbid obesity.
• Modified BPD (75-225 cm) is suitable for superobesity; VBG requires careful patient selection due to high long-term failure rates.