4. Taking the Leap: An Unscientific Examination of the Scientific Literature

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Deciding to have bariatric surgery can feel like taking a leap of faith. Is it going to work? Can I ever eat again? Why not just change my eating habits and exercise? Am I doing the right thing?

While it felt like a relief to take the plunge and make the decision to have surgery, I had plenty of questions and even more doubts. I joined some Facebook support groups for people going through the process or those who had already done it and have their own experiences to share. But, along with inspiration and knowledge, in these groups you can also find a skewed perspective and a lot of negativity and judgment. If you only pay attention to these “support” groups, you may come away thinking most people regain some or all of the weight, you will never be able to eat “real” food again, you will walk around with a wheelbarrow of extra skin, and you’ll frequently poop your pants.

But I wanted to know the reality. What do we know from research? What’s the actual likelihood of these things happening to me? What can I really expect? So I set out to find out for myself.

A few caveats: Each person’s experience with weight loss surgery is unique to them, as everyone brings their own medical history to the operating table. Similarly, everyone’s compliance with their doctor’s instructions varies. Also, I am not a scientist nor an academic, and I don’t have unlimited access (nor the time) to read decades of research and crunch the numbers. Finally, I am focusing on laparoscopic gastric sleeve because it’s the surgery I’m having. The research I’m citing here is some of the most recent and relevant information I could find. I tried to write it in layman’s terms so most people could understand it, but as with any scientific research, there are subtleties to the studies that I am not able to tackle here.

Will I die on the table?

In an early study done in 2007, of 120 patients undergoing surgery, no one died during surgery, but one patient died later on (i.e., 0.8%).¹

In addition, a 2010-2011 study (published in 2015) of 24,117 patients (both gastric sleeve and gastric bypass) showed that gastric sleeve has a lower 30-day risk of “serious morbidity.”  Those with gastric sleeve had a shorter operating time, lower rate of blood loss requiring transfusion, lower rate of deep wound infections, lower serious morbidity rate (i.e., health issues), lower 30-day reoperation rate, but higher rate of deep vein thrombosis. According to the study, “patients who were older, had higher BMI, smoked, or had hypertension were at significantly greater risk of serious morbidity.”6

Later research shows excellent mortality results, as in a 2017 study (published 2018) of 8,385 patients (lap band, gastric bypass, and gastric sleeve) versus 25,155 similar patients who received “usual care” (no surgery). Over 4.5 years, 1.3% of the surgical patients died, compared with 2.3% of those who did not undergo surgery–a significant difference. This study looked at “all-cause mortality.”³

Conclusion: Gastric sleeve is a safe procedure, with virtually no risk of mortality and very low risk of complications during surgery.

Will I gain the weight back?

In the same study cited in 1 above, 16 patients (i.e., 13.3%) later had a second procedure done within five years.¹

According to a 2011 study studying 937 patients, 106 (i.e., 11.3%) secondary procedures were performed within five years. 88 patients (i.e., 9.3%) experienced insufficient weight loss or weight regain.4

Conclusion: Odds are about 50/50 whether you will regain the weight, but results aren’t left to chance. Gastric sleeve is an effective solution if you stick with the program and use your “tool.”

What results can I expect?

According to a 2009 study, 13 patients received gastric bypass, while 14 patients received a gastric sleeve. Body weight and BMI “decreased markedly … and comparably.” Glucose levels improved significantly in both sets of patients (thus showing promise for those with diabetes).²

A 2012 study (published in 2013) of 135 gastric bypass patients and 114 gastric sleeve patients showed excess weight loss within a four-year period of 66±13.7% in the first group and 65±14.9% in the second group. In addition, comorbidities (i.e., two or more chronic diseases or conditions) improved or resolved within the first year.7

More recently, a 2019 study shows that average excess weight loss beyond 10 years is around 50%.9 And another 2019 study of more than 500 patients (gastric bypass and gastric sleeve) after almost five years showed mean total body weight loss of 27.7±11.7% in gastric sleeve and 19.4±11.1% in gastric bypass.10

Conclusion: While many people don’t seem to reach their “goal weight,” most lose more than half of their excess weight. (Expected weight loss is often measured in loss of excess weight.) Since many of these studies are long-term (approximately five years later), I would assume at least some of the patients have regained some of the weight that they lost, and they have eventually arrived at about 2/3 of their excess weight lost.

What are the side effects or complications?

In the same study cited in 1 above, there were two early leaks (i.e., 1.7%).¹ In the same study cited in 4 above, 17 patients (i.e., 1.8%) experienced staple line leakage. However, in a 2007 study of six patients [yes, small sample size] who had gastric leaks, one patient was treated with a Wallstent and required a total gastrectomy six months later. In the other five patients, coated stents were successfully removed, and the gastric leaks were completely sealed. Results indicate that leaks may be treated successfully with coated stents.5

Also in 2007, a study of 148 patients indicated a 2.9% (4 patients) rate of major complications, include one leak, one hemorrhage, one postoperative abscess, and one sleeve stricture that required endoscopic dilation. One late complication of choledocholithiasis and bile duct stricture required a Whipple procedure. 16 of the patients underwent the sleeve surgery as a reoperation of a prior bariatric surgery. In addition, one case was aborted and two cases were converted to an open procedure secondary to dense adhesions. No patients died. All but three of the surgeries were done laparoscopically. According to the study, “[gastric sleeve] is a relatively safe surgical option for weight loss as a primary procedure and as a primary step before a secondary nonbariatric procedure in high-risk patients.”8

In the same study cited in 9 above, diabetes remission is up to 62%, while the long-term issue found in many studies is gastro-esophageal reflux, or heartburn.

In the same study cited in 10 above, complications were as follows:

  • Overall complications: 23.8% in gastric bypass and 10.8% in gastric sleeve
  • Reoperations: 17.1% in gastric bypass and 2.5% in gastric sleeve
  • Readmissions: 16.7% in gastric bypass and 6.2% in gastric sleeve
  • Early postoperative complications: 2.6% in gastric bypass and 9.2% in gastric sleeve
  • Length of stay: 1.5±2.2 days in gastric bypass and 5.2±10.9 days in gastric sleeve
  • Quality of life (reported):  higher in gastric sleeve
  • Satisfaction (reported): higher in gastric sleeve
  • Regurgitation: lower in gastric sleeve
  • Dysphagia: lower in gastric sleeve

Conclusion: Gastric bypass seems be very low risk, with few or minor side effects; however, the risk of continuing to have or developing minor, regular heartburn is high enough to take into consideration.

What can I expect the process to be like?

This is why I started blogging about my journey. I wanted to not only document that journey, but also collect my thoughts about myself and my struggles. In coming posts, you will find more detailed descriptions of the prerequisites for surgery, the nutritional components of bariatric weight loss, and a step-by-step account of my ups and downs, successes, setbacks, and of course, my thoughts. I am blogging about this as I go through the experience, so please comment on my posts or go to my Contact Me page to send me a message. I would love to dialogue with you!

One final note: Uniquely Koka isn’t solely about my weight loss journey. In between posts about this topic (which will be top of mind for quite a while), I will continue blogging about my life and thoughts–about anything and everything–as I live it. So subscribe to kokablog.com and follow me as I continue to live and learn.

Sources:

¹Laparoscopic Sleeve Gastrectromy–Influence of Sleeve Size and Resected Gastric Volume. Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G. Obesity Surgery. October 2007, 17:1297.

²Improvement in Glucose Metabolism After Bariatric Surgery: Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Laparascopic Sleeve Gastrectomy: A Prospective Randomized Trial. Peterli R, Wölnerhanssen B, Peters, T, Devaux N, Kern B, Christoffel-Courtin C, Drewe J, von Flüe M, Beglinger C. Annals of Surgery. August 2009, Volume 250 Issue 2, p 234-241.

³Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality. Reges O, Greenland P, Dicker D, et al. JAMA. 2018;319(3):279–290.

4 Failure of Laparoscopic Sleeve Gastrectomy – Further Procedure? Weiner RA, Theodoridou S, Weiner S. Obesity Facts. 2011;4(suppl 1):42–46.

5 Treatment of Gastric Leaks with Coated Self-Expanding Stents after Sleeve Gastrectomy. Serra C, Baltasar A, Andreo L, Pérez N, Bou R, Bengochea M, Chisbert JJ. Obesity Surgery. July 2007, Volume 17, Issue 7, p 866-872.

6 Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid Obesity. Mid-Term Results. Obesity Surgery. Vidal P, Ramón JM, Goday A, Benaiges D, Trillo L, Parri A, González S, Pera M, Grande L. March 2013, Volume 23, Issue 3, p 292–299.

7 Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP. Presented at the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014. Young, MT, Gebhart A, Phelan MJ, Nguyen NT. Journal of the American College of Surgeons. Volume 220, Issue 5, May 2015, p 880-885.

8 Complications After Laparoscopic Sleeve Gastrectomy. Presented as a podium presentation at the 24th Annual Meeting of the American Society for Bariatric Surgeons, San Diego, California, June 11–16, 2007. Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Surgery for Obesity and Related Diseases. Volume 4, Issue 1, January–February 2008, p 33-38.

9 Long-Term Results of Sleeve Gastrectomy. Kraljevic M, Peterli R. Therapeutische Umschau. Revue Therapeutique. 01 Sep 2019, 76(3):150-153.

10 Long-Term Matched Comparison of Adjustable Gastric Banding Versus Sleeve Gastrectomy: Weight Loss, Quality of Life, Hospital Resource Use and Patient-Reported Outcome Measures. Johari Y, Ooi G, Burton P, Laurie C, Dwivedi S, Qiu Y, Chen R, Loh D, Nottle P, Brown W. Obesity Surgery. 09 Set 2019, 0960-8923.

One thought on “4. Taking the Leap: An Unscientific Examination of the Scientific Literature

  1. sleevingitbehind September 17, 2019 / 12:49 pm

    Nice to hear that someone else found the Facebook ‘support’ groups to be a rather hostile environment. I joined two pre-op and any question I asked or post I made attracted a barrage of conflicting advice and ‘well it depends how badly you want it’ type comments so I quickly left. I’ve joined one administered by my weight loss provider post op so I can share my actual experience to counterbalance the negative and often bullying replies to questions.

    Like

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