Comparing surgeries: The Official Conclusion

It's official. New 2008 bariatric guidelines from the AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR  METABOLIC & BARIATRIC SURGERY have been released that conclude that no surgery is better than DS in long term weight loss.  (Guidelines are used by insurance companies to determine quality of care and reimbursement and represent the state of the art care. They are based on an analysis of published studies that were considered scientific enough to include.)

Everyone should look at these guidelines for their advice about nutrition and supplementation as well as post op testing. It's a little rough going if you don't know the medical language but it's worth wading through for the postop care stuff.  Here's the link for the full text: http://www.aace.com/pub/pdf/guidelines/Bariatric.pdf

This is from table 4 on page 10. After 7-10 years, RNY excess weight loss ranges from 25% (!) to 68%, gastric banding from 14% (!!) to 60%, and DS from 60 to 80% (although we all know some people who are maintaining 100% excess weight loss at 7-10 years, they weren't part of these studies used to write the guidelines). So, if you had 100 pounds to lose, give the worst case scenario, you would still have 86 pounds left with the band, 75 with RNY and 40 with DS. The best of the band results is equivalent to the worst of the DS results at 7-10 years. 

Reported Weight Loss as Percentage 

of Excess Body Weight After Bariatric Surgery  

                                                                                                                                    

Follow-up period (y) (the first number is 1-2 years, the second is 3-6 and the third is 7-10 (if data exist).

                                                      

Procedure         1-2        3-6        7-10 

                                                                                                                                    

Vertical banded gastroplasty  50-72   25-65   … 

Gastric banding 29-87   45-72   14-60 

Sleeve gastrectomy   33-58   66 … 

Roux-en-Y gastric bypass  48-85   53-77   25-68 

Banded Roux-en-Y gastric bypass  73-80   66-78   60-70 

Long-limb Roux-en-Y gastric bypass  53-74  55-74 … 

Biliopancreatic diversion ± DS  65-83   62-81   60-80   

Elsewhere, I have a lot of problems with some of what the document states, since they threw BPD data with DS data in a kind of sloppy way.  It's not a perfect document, but it shows you how far DS has come even in the competitive bariatric surgery world. It's important to note that no one has done a long-term study that head-to-head compares DS to RNY to Band (and that study will probably never be done). I hope this helps some pre-ops negotiate  with their insurance companies.

Thanks for sharing Nancy!
Peace and good.

thank you for sharing this, Nancy! This is awesome!

Thanks for posting that, Nancy! Very interesting reading.

 

Fantastic post, thanks! I am going to check out the link and I think I'll send it to my surgeon and PCP in hopes that they will begin to recognize DS as a very effective surgery. Thanks again.

THANK you Nancy, that is some awesome information. Bookmarked!

             

5'7"   SW 268lbs BMI 42/ CW 132lbs BMI 20.7 / GW 140lbs
136lbs  Lost 

                            I Ymy duodenal switch
 

 

OMG NANCY ...LOVE YOUR POSTS!!!!! With your permision I would like to post it some place else....obviously as always giving you the credit.

Scott

main board perhaps LOL

 Scott: The more knowledge the better. Pass it on!