BARIATRIC SURGERY - Health Plan of Nevada

WOU001
biliopancreatic diversion (BPD) with or without duodenal switch. All four procedures may be performed
by open or laparoscopic technique.
Surgical treatment of obesity offers two main weight-loss approaches: restrictive and malabsorptive.
Restrictive methods are intended to cause weight loss by restricting the amount of food that can be
consumed by reducing the size of the stomach. Malabsorptive methods are intended to cause weight loss
by limiting the amount of food that is absorbed from the intestines into the body. A procedure can have
restrictive features, malabsorptive features, or both. The surgical approach can be open or laparoscopic.
The clinical decision on which surgical procedure to use is made based on a medical assessment of the
patient's unique situation.
Many patients elect surgery to remove redundant skin or redundant skin and adipose tissue are common
following bariatric surgery. Physiologic functional impairment as a consequence of such redundant tissue
is uncommon. However, many patients consider their physical appearance unacceptable as a result of
redundant skin and adipose tissue.
CLINICAL EVIDENCE
The criteria for patient selection for bariatric surgery were relatively uniform among various authors and
corresponded to criteria recommended by the American Society for Bariatric Surgery (ASBS) and the
Society of American Gastrointestinal Endoscopic Surgeons (SAGES). These criteria include (ASBS,
2000):
• BMI 35 to 40 with obesity-related comorbid medical conditions
• BMI > 40 without comorbidity if the weight adversely affects the patient
• Demonstration that dietary attempts at weight control have been ineffective
Sjostrom et al. published a prospective controlled study of patients that had gastric surgery (average BMI
of 41) and matched them with conventionally treated obese control subjects. Two treatment groups were
identified: those who had surgery two years prior (4,047 patients) and those who had it 10 years prior
(1,703). After two years, the weight had increased by 0.1% in the control group and decreased by 23.4%
in the surgery group. After ten years, the weight in the control group had increased by 1.6% and had
decreased in the surgical group by 16.1%. In addition to total weight loss, they measured laboratory
values and lifestyle changes. The authors concluded that bariatric surgery appears to be a viable option
for the treatment of severe obesity and resulted in long term weight loss, improved lifestyle and
improvement in risk factors that were elevated at baseline (Sjostrom, 2004).
Obese individuals with metabolic syndrome (MS), a clustering of risk factors that include high levels of
triglycerides and serum glucose, low level of high-density-lipoprotein cholesterol, high blood pressure
and abdominal obesity, are at high risk of developing coronary heart disease and type 2 diabetes mellitus.
A study by Lee et al. concluded that MS is prevalent in 52.2% of morbidly obese individuals and that
significant weight reduction one year post surgery markedly improved all aspects of metabolic syndrome
with a cure rate of 95.6%. They also note that obesity surgery performed by laparoscopic surgery is
recommended for obese patients with MS (Lee, 2004).
Bariatric Surgery Page 8 of 30