Published in July 2014 Issue             

No Change in Retinopathy in Diabetes 2 Years After Surgery
(ADA Scientific Session)

Results from the STAMPEDE clinical trial presented at the American Diabetes Association 2014 Scientific Sessions show two years after bariatric surgery patients had no change in diabetic retinopathy. In the study, 150 patients with obesity and uncontrolled type 2 diabetes were randomized to intensive medical therapy (50 patients), Roux-en-Y gastric-bypass (50) or sleeve gastrectomy (50). Patients were 20 to 60 years old, had an HbA1c greater than 7% and a BMI of 27 to 43. Approximately 80% of patients had no evidence of retinopathy at baseline. After two years, there was no significant change in retinopathy scores for patients who had no retinopathy, mild to severe nonproliferative retinopathy, or proliferative retinopathy. The study is the first prospective, randomized clinical trial to show that intensive medical management vs. gastric bypass does not increase the retinopathy incidence or progression, nor does it increase the rate of vision loss or changes in intraocular blood pressure (a sign
of glaucoma).

Revisional Surgery After Failed Gastric Banding (SOARD)

Converting a gastric band to gastric bypass in a one-stage procedure is safe and feasible when performed in a specialized institution, according to a study (article in press) in SOARD. Overall 1778 one-stage procedures were performed without complication, and only 8 (4%) of patients required reoperation within 30 days. The mean follow-up was 40 months.

Better Long-term Diabetes Outcomes with Sleeve Gastrectomy vs. Medical Management (ICE and Endocrine Society Joint Meeting)

Laparoscopic sleeve gastrectomy helped adults with type 2 diabetes achieve better blood glucose control than standard care alone, according to research presented at the joint meeting of the International Congress of Endocrinology and the Endocrine Society. Investigators reviewed medical records of veterans with diabetes, ages 18 to 80, undergoing surgery at a VA medical center in a major metropolitan area. Two years of chart data of 30 surgical patients were compared to 23 control patients. All patients had received medical treatment and been part of the MOVE national weight management program designed by the VA National Center for Health before being offered surgery. Significant improvements in BMI and HbA1c were seen in patients with surgery at one year, with improvements sustained through the end of two years; BMI decreased from 46 to 34 and HbA1c from 7.25% to 5.98%. At study completion, 76% of surgery patients discontinued or reduced their diabetes medications, compared to 26% of patients who received medical treatment only.

Patients Continue to Lose Bone at Least 2 Years After Bariatric Surgery, Shows Study (ICE and Endocrine Society Joint Meeting)

A 50-patient study showed gastric bypass patients continued to lose bone for at least two years after surgery, even after their weight stabilizes. Bone density was 5% to 7% lower at the spine and 7% to 10% lower at the hip, compared with patients who did not have surgery. The principal investigator commented that the long-term consequences of this substantial bone loss are unclear, but it might increased risk for fracture or breaking a bone. Additionally, researchers noted that although bariatric surgery may cause potential risks to bone health, it is “the most effective treatment for severe obesity and offers phenomenal health benefits.” The findings were presented at the annual joint meeting of the International Congress of Endocrinology and the Endocrine Society meeting.

Reoperative Bariatric Surgery Yields Low Complication Rates, Substantial Weight Loss at 1 Year (Digestive Disease Week)

Analysis of 451,485 operations included in the prospective database, BOLD, shows reoperative bariatric surgery has “impressively low major morbidity and mortality, substantial one year weight loss and a high rate of resolution of obesity related conditions.” The data was presented at Digestive Disease Week and it was noted that outcomes are better than believed by insurance carriers, who often deny coverage because of a misperception that complication rates are high and benefits are uncertain. The analysis also found outcomes for primary and revision surgeries were comparable.

Improving Outcome of Bariatric Surgery: Best Practices in an Accredited Surgical Center (Obesity Surgery)

A retrospective analysis, published in the July issue of Obesity Surgery, of data collected prospectively on patients undergoing bariatric surgery at St Luke's University was performed to evaluate the feasibility and safety of a clinical pathway in managing patients undergoing bariatric surgery in a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited center. The primary outcomes were length of stay, 30-day readmission, complication and reoperation rates. Two hundred twenty-nine patients were included in the analysis (80.4% females and 19.6% males). Seventy-one patients (31%) had laparoscopic sleeve gastrectomy, and 158 patients (69%) had laparoscopic Roux-en-Y gastric Bypass. The average length of stay was 32.45 hours. The 30-day readmission rate was 3.0%. The 30-day complication rate was 2.6%. The 30-day mortality rate was zero. A cost analysis of the savings accrued was also performed and the average prospective cost savings were $2,016 and $1,209 per LRYGB and LSG patient, respectively. The study authors concluded that the center’s bariatric surgery clinical protocol is feasible and safe with substantial prospective cost savings.

Fast-Track Bariatric Surgery Improves Perioperative Care and Logistics Compared to Conventional Care (Obesity Surgery)

To determine methods for optimizing perioperative care a study, published in the July issue of Obesity Surgery, compared surgical outcomes of patients who received conventional perioperative care from January to April 2011, to patients in a fast-track surgery program from April to June 2012. Researchers compared perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). Primary endpoints were surgery and hospitalization time, and secondary endpoints were intraoperative medication use and complication rates. BMI and waist circumference were significantly lower in the fast-track cohort compared to patient receiving conventional care. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 minutes. Surgery time was reduced from 80 to 56 minutes, and mean hospital stay was reduced from 65 to 43 hours. Major complications occurred in 3% of fast-track patients, compared to 4% in the conventional care group. Researchers concluded that the introduction of a fast-track program improves short-term recovery and may reduce direct hospital-related resources.