Laparoscopic Gastric Bypass Surgery Safe in Type 2 Diabetes

Laparoscopic gastric bypass surgery in patients with type 2 diabetes, once considered a high-risk procedure, now carries a complication and mortality rate comparable to some of the safest and most commonly performed surgeries in America, according to new data presented at Obesity Week 2014. 

Researchers at the Cleveland Clinic looked at 66,678 patients with diabetes, including 16,509 who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB).

The 30-day complication rate was 3.4% for patients who underwent LRYGB, according to the study results, which was on par with those for laparoscopic cholecystectomy and hysterectomy.

The researchers also found that hospital stays and readmission rates were similar to laparoscopic appendectomy.

The month-long mortality rate for metabolic or diabetes surgery was 0.30%, which is about one-tenth the risk for death after cardiovascular surgery.

Also, gastric bypass patients had significantly better short-term outcomes in all examined variables compared with laparoscopic colon resections.

Study co-author Ali Aminian, MD, Clinical Scholar of Advanced Metabolic and Diabetes Surgery at the Cleveland Clinic in Ohio, said the perception has been that gastric bypass is a very risky operation. However, he said the reality is that it is as safe, if not safer, than many of today’s commonly performed surgeries.

Moreover, he said the risk-to-benefit ratio of gastric bypass for diabetes and obesity is very favorable. In addition to significant weight loss, improvement in diabetes or remission can occur, said Dr. Aminian.

“The mortality rate of gastric bypass was 3 in 1,000 diabetic patients, which was comparable to total knee arthroplasty,” he said.

Dr. Aminian also noted that earlier intervention with metabolic surgery may prevent patients from undergoing more dangerous surgeries further down the road. 

“This study is the first large series on diabetic patients based on a national dataset that examines and compares the safety profile of various procedures including a diabetes/metabolic procedure,” Dr. Aminian told Endocrinology Advisor. 

“Findings of this study indicate that the mortality risk of gastric bypass is one-tenth that of cardiovascular surgery, and earlier intervention with metabolic/diabetes surgery to treat diabetes and metabolic syndrome may eliminate the need for some later higher-risk procedures to treat cardiovascular complications of diabetes.”

The database included 66,678 patients with diabetes who had 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 with those of the 16,509 patients in the group who had LRYGB.

Studies have shown that gastric bypass procedures can have a nearly immediate effect on patients with type 2 diabetes, even in a matter of hours or days and long before weight loss occurs. 

John Morton, MD, Chief of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, said this study along with others can help patients with diabetes and their physicians make more informed and realistic decisions about the potential risks and clear benefits of metabolic surgery.

Reference

1. Aminian A et al. A701: How Safe is Metabolic/Diabetes Surgery? Presented at: Obesity Week 2014; Nov. 2-7, 2014; Boston.