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OUTCOMES
The success of bariatric surgery is measured by weight
loss maintained over time, improved health, and each patient's
personal assessment of improved well being.
Weight
Loss
Weight loss that is significant must be maintained.
Yo-yoing is unfortunately all too common. Bariatric surgeons should
follow their patients indefinitely, and report their patients'
outcomes to their colleagues and in the medical literature. The ASBS
considers reports of weight loss outcomes of patients less than five
years post-operative, preliminary.
One of the first reports
of longterm weight loss outcomes on VBG patients was Dr. Sweet's
series, reported in the ASBS official journal, and presented at the
ASBS annual meeting in 1994. That report of his patients five to
twelve years out from VBG prompted Dr. Sweet, and others in the
ASBS, to increasingly perform RYGB. Though the majority of his
patients with VBG had done well, and had averaged 50% loss of their
excess weight, maintained over five to twelve years, a significant
minority had not done well, thus prompting use of a more effective
procedure.
In a
carefully followed group of patients operated on at East Carolina,
now eighteen years post-operative, they have maintained an average
excess weight loss of just over 50%. (see illustration of the
operative technique then). With significantly smaller pouches, and
longer "bypass" segments now commonly used by many members of the
ASBS, long-term excess weight loss is expected to be even better, in
the 60-70% range.
Ultimately
individual weight loss is dependent on how well each person,
carefully evaluated and counseled pre-operatively, utilizes his
operative "tool." Patients with significant exercise impairment,
those with diabetes, and often older patients, don't generally do as
well long term. The truth is that it takes commitment, and generally
lifestyle changes with regard to exercise, eating, and drinking, if
one is to achieve and maintain significant weight loss.
Health
Improvement
With weight loss
come improvements in an individual's health.
Most significantly:
- two-thirds of
gastric bypass (GB) patients who previously were treated for high
blood pressure with medication no longer require any blood
pressure medication;
- diabetics not
on insulin but using other medications to regulate blood sugar
show immediate and dramatic improvement in their blood sugar
levels after GB, 80% of these patients return to normal blood
sugar range without the need to take medication;
- people with
asthma show marked improvement;
- problems with
sleep apnea become less severe or disappear entirely;
- less joint
pain and slower deterioration due to arthritis are other results
of weight loss;
- one
continuing European study indicates that severely obese patients
who undergo bariatric surgery have fewer early deaths than those
patients treated with diet and exercise.
Self
Assessment
Feeling good
about yourself is an important indicator of a successful outcome. In
almost all cases, patients who undergo bariatric surgery report that
they do feel better about themselves, and become more involved with
family, friends, and work. These individuals consistently rate their
experience as one of marked improvement.
For details about the
risk and side effects of VBG and RYGB, please click on Risks and
Side Effects. |
