Bypass for Diabetes as Safe as Appendectomy, Study Finds

Surgical treatment of type 2 diabetes (T2DM) with laparoscopic gastric bypass surgery is as safe as other commonly performed surgical procedures, according to a new study.

“Laparoscopic Roux-en-Y gastric bypass can be considered a safe procedure in diabetics, with short-term morbidity comparable to common procedures such as cholecystectomy and appendectomy and mortality similar to knee arthroplasty,” state the authors.

Early outcomes from laparoscopic gastric bypass surgery show impressive results. Up to 80% of people show no signs of diabetes after surgery, and patients usually lose 60% to 80% of their extra body weight. However, despite recent results showing antidiabetic effects of laparoscopic Roux-en-Y gastric bypass, the safety profile of metabolic surgery for diabetes overall has been a matter of concern among patients and physicians.

Researchers from the Cleveland Clinic reviewed a national database of more than 66,000 patients with diabetes who had undergone various surgical procedures, including laparoscopic gallbladder surgery, appendectomy, partial colon resections, hysterectomy, heart surgery, and total knee replacement between 2007 and 2012. The complication and mortality rates of these procedures were compared to those seen among more than 16,000 patients in the group who had laparoscopic gastric bypass surgery.

They found the 30-day complication rate associated with laparoscopic gastric bypass surgery was 3.4%, about the same rate as laparoscopic cholecystectomy and hysterectomy. Hospital stays and readmission rates were similar to laparoscopic appendectomy. The month-long mortality rate for laparoscopic gastric bypass surgery was 0.3%, comparable to that of total knee replacement, and about one-tenth the mortality risk after cardiovascular surgery. Laparoscopic gastric bypass surgery patients had significantly better short-term outcomes in all examined variables compared to laparoscopic colon resections.

“The perception has been that gastric bypass is a very risky operation, but the reality is, it is as safe, if not safer, than many of the most commonly performed surgeries in America,” said lead author Ali Aminian, MD, Clinical Scholar of Advanced Metabolic and Diabetes Surgery at Cleveland Clinic. “The risk-to-benefit ratio of gastric bypass for diabetes and obesity is very favorable. There’s significant weight loss, diabetes improvement or remission, and a relatively low complication and mortality rate. In addition, earlier intervention with metabolic surgery may eliminate the need for some later higher-risk procedures to treat cardiovascular complications of diabetes.”

This study, along with many others, can help patients with diabetes and their doctors make better informed and realistic decisions about the potential risks and clear benefits of metabolic surgery, commented John M. Morton, MD, Chief, Bariatric and Minimally Invasive Surgery, at the Stanford University School of Medicine. “Metabolic surgery is a safe and effective treatment, and the data shows, it’s only getting safer,” he said.

The study authors state that the database used only includes short-term postoperative outcomes and that more studies on the long-term effects of surgery are needed.

Dr. Aminian presented the results of the study at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery in San Diego during ObesityWeek 2014.

References:

Aminian A, Brethauer SA, Kirwan JP, et al. How safe is metabolic/diabetes surgery?Diabetes Obes Metab. 2014 Oct 29. doi: 10.1111/dom.12405. [Epub ahead of print]