PCORnet Bariatric Surgery Research and Outcomes

Hi, this is Tom Inge. I’m a professor of surgery in pediatrics at the University of Colorado Denver and Children’s Hospital Colorado. I direct the Bariatric Surgery Center at Children’s Hospital Colorado, and I’m here today to talk to you about a recent study that’s been published with some exciting results. Just in the way of
background, severe obesity affects millions of adolescents today, and lifestyle modifications
including dietary interventions as well as physical
activity have very limited effectiveness for controlling
ongoing weight gain. What we’ve found is
that even pharmacologic or drug interventions have
limited effectiveness, too. Increasingly, we are realizing
that weight loss surgery should be considered a treatment option for those adolescents who
have become severely obese and particularly for
those who have developed a health problem or even quality of life impairment due to the extra weight. So the study I’d like to talk to you about is the comparative effectiveness of bariatric procedures among adolescents, the PCORnet bariatric study. With 544 patients analyzed,
this study is the largest study to date which provides adolescent weight loss surgery outcome data. In this study, we also
look for the first time at modern trends for use
of specific procedures in adolescents undergoing
bariatric surgery. In this work, we estimate
the long-term weight loss outcome for three specific procedures at one, three, and five years. The results of the study are shown here. As you can see, there
has been a major shift in the dominant procedure type
over time with the largest change being increased
use of sleeve gastrectomy. The use of sleeve gastrectomy increased from approximately 13%
of cases to 83% of cases over the course of 10
years, from 2005 to 2015. At the same time, we
saw a decline in the use of Roux-en-Y gastric
bypass, declining from about 50% of cases to 25% of cases
over the same time period. There has been a marked decline in the use of adjustable gastric banding
over the same period of time with extremely few cases being done now. The sleeve gastrectomy is a procedure that actually removes
about 80% of the stomach. So under general anesthesia,
the anesthesiologist will insert a large tube
into the patient’s mouth and pass this tube down the
esophagus and into the stomach. The surgeon will then use this as a guide to remove the portion of stomach
to the right of the tube. With this operation, about
80% of the stomach is removed. This results in a very
narrow and small new stomach, which means that only very
small meals can be eaten. Before gastric surgery,
a patient could have had four to six cups of food,
whereas after a sleeve gastrectomy, a much smaller
stomach can only hold about a half a cup of
food during the meal. But even more importantly,
the surgeon has also removed that portion of that stomach that talks to the hunger centers in the brain, and another result of
this operation, then, is that appetite is dramatically reduced. This next graphic gives us the
major message of the study. This shows body mass
index change over time, and for the adjustable gastric band, about 10% weight loss can be
seen, but the sleeve and bypass provide the most impressive findings. We see an average weight loss of about 30% for the sleeve gastrectomy as
well as the gastric bypass. The weight loss is gradual
over the first 18 months, and then weight loss
is largely maintained. That means that most of the individuals who had sleeve gastrectomy
or gastric bypass experienced about 25 to 30% weight loss and maintained that weight
loss out to five years. In addition to weight loss
and procedure preference, the study also looked at 30-day
postoperative complications. Importantly, there were no
deaths reported within 30 days. And as you can see in the
table, only 3% of the patients required re-operative procedures or subsequent endoscopy or
percutaneous interventions. We also found the very low incidence, about 4%, of blood clots forming, or something called
venous thromboembolism. In fact, any adverse event within 30 days, including things like
urinary tract infection, pneumonia, or even a delay in discharge happened at only about 5% of the time. So overall, looking at
30-day complications, there were very few patients
that had complications, and those complications were very similar to that which have been documented and widely reported from adult series. So in conclusion, from this PCORnet study, we can say that sleeve
gastrectomy has certainly become the dominant operation performed for adolescents with severe obesity. We can also say that
this is the largest study to date with 544 participants and a very long follow-up of five years. Adolescents undergoing gastric bypass and sleeve gastrectomy
experienced excellent weight loss and maintained this weight loss over a three- to
five-year follow-up period while patients who had
adjustable gastric banding lost the least amount of weight
over the same period of time. Surgical and medical
complications were infrequently observed within the
perioperative period of 30 days. This has been Dr. Tom Inge at
Children’s Hospital Colorado. For more information, give us a call or visit the link on the screen.

Leave a Reply

Your email address will not be published. Required fields are marked *