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When asking about how long you live
after WLS, the common answer for the lack of either long term patients or
studies showing longevity is that the older procedures are not done any more and
the newer procedures are too new for that type of evidence. Any surgeon
that I have asked, does not know any patients over 10 years post op.
Many
surgeons answer the longevity question as Dr Alan Wittgrove of the Alvarado Clinic
did in the online interviews at the time of Carnie Wilson's gastric bypass:
Question: Dr. Wittgrove, I really need to know
about how this surgery
will effect me when I am old (70, 80 and 90's)
Dr. Alan Wittgrove:
Hopefully you will live that long.....
People who are morbidly obese don't have
long life spans...
Ideal body weight tables were based on
actuarial data....
It is commonly known that people who are
morbidly obese die earlier than those who are not morbidly
obese.
The bottom line is no one seems to know.
It's likely true that some longer term patients have merged with the general
population and do not identify themselves as patients. To what extent this
is true is again, unknown.
The survival rate for the Billroth II, a surgery
which is similar to the gastric bypass (but leaves more of the stomach so may be
less risky), was an average of 20-25 years. I have seen Billroth II
patients live 40 years after surgery but not without serious health issues.
It is thought that some surgeons are keeping
track of patients on a longer term basis. But to date, little to no
longevity data has been released on the gastric bypass surgery despite the fact
that it's been done for 40 years.
Dr Paul Ernsberger, Associate Professor of Nutrition at Case
Western Medical School, stated, on a Donahue show:
Well, the gold standard in medicine is the controlled clinical trial. We
don’t go subjecting 100,000 people to a surgical procedure without doing a
controlled clinical trial or dozens of clinical trials, and then looking at the
results. Do you know how many clinical trials have been published on weight-loss
surgery or gastric bypass? Zero. None of them have compared it to clinical
conservative treatment and found it to be superior for life expectancy or for
anything else other than, you know, risk factors. A number of trials have
been started, and the final results have never been reported. We have to
ask, you know, why haven’t we seen the final results? I think it’s because it’s
bad news.
The ASMBS will tell you that the immediate death
rate from bariatric surgery is 1 individual for every 1000 surgeries. This
seems be different depending on which surgeon you talk to. For example,
Pories in Sabiston's Manual On Surgery, medical school text book, stated the
death rate as 1 in 100, a percentage which other surgeons have agreed with.
Dr Flancbaum feels the death rate is about 1 in 200 surgeries.
A study headed by Dr David Flum in Washington which analyzed the case histories of 62,000 gastric bypass
patients, found that within the first 30 days after surgery, the death rate had
been 1 death every 50 surgeries. This was considerably higher than even
the worst estimate. Dr Flum commented on CNN news that it was time for "a
reality check on this surgery".
report delivered to the College of surgeons in Oct
21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A
Population-Based Study]
The difference between the ASMBS figures and those found in the David Flum
study, may be that many gastric bypass deaths are not attributed to gastric
bypass but rather to other reasons.
In the Fresno Bee investigation (Fresno, CA,
2001), it was discovered that 27 deaths directly linkable to gastric bypass
surgery in the last three months of 2001, were recorded as deaths from other
causes.
A three-month Fresno Bee investigation
reviewed death certificates, hospital data and lawsuits to determine the number
of area deaths following gastric bypass surgery. The exact number of fatalities
is hard to pin down. Death certificates don't always cite gastric bypass as the
cause of death, but instead often attribute the death to complications such as
heart attacks, blood clots or morbid obesity.
But even at the optimistic, 1 death in 1000
surgeries, gastric bypass surgery is much more risky than other types of
surgeries like a hysterectomy. One reason often given to prospective
patients for the higher risks is that bariatric surgery, in general is done on a
higher risk population (obese people). While there is some truth in this,
note in the comparison below that the adjustable lap band surgery, done on the
same population as the gastric bypass surgery, has a MUCH lower death rate:
Table death rates (death after surgery or within
3 days of surgery):
Hysterectomy: 1 death in 100,000
Adjustable Lap Band: 1 - 3
deaths in 7000
Liposuction : 1 death in 5000
gastric bypass: 1 death in
50 (Dr David Flum study of 62,000 gastric bypass patients ).
What about long term complications possibly
leading to death?
The Mayo Clinic study in 2000 on gastric bypass
reported that 20-25 percent of the patients had developed life threatening
complications within five years. Those are
similar odds to the medication, Phen-Fen which was considered risky enough to take off the
market.
But the rate of life threatening
complications may be even higher:
"The American Society of Bariatric Surgery
says weight loss surgeries have increased from about 20,000 in 1995 to an
estimated 45,000 in 2001. It estimates a 7 percent complication rate.
"But Livingston's own study of 800 patients found complication rates of
20 to 40 percent, with everything from intestinal leaks to nutritional
deficiencies. "
ABC News story, March 2001
Edward Mason, inventor of the
gastric bypass wrote this in an article in 1999:
"For the vast
majority of patients today, there is no operation that will control weight to
a "normal" level without introducing risks and side effects that over a
lifetime may raise questions about its use for surgical treatment
of obesity." Edward Mason
(MD, PhD - inventor of the gastric bypass)
http://obesitysurgery-info.com/masonpromvgb.htm
Dr Terry Simpson commented
about the RNY (gastric bypass):
"The RNY trades one disease for another: it trades obesity for malabsorption.
By re-arranging your guts you sometimes have severe side effects, and can have
long-term problems such as iron deficiency anemia, calcium deficiency leading
to osteoporosis." (Dr Terry Simpson, MD, WLS surgeon)
The
Dartmouth-Hitchcock study ran a statistical analysis and concluded that
gastric bypass patients who kept their weight off might live 3 years longer
than obese people. However about this study, Dr Pope warned:
"The data from the study may be something obese patients can
look at and realize that their life could be extended by this operation, but I
don't think they can definitively bank on the data. This study needs to be
confirmed by long-term prospective studies that follow patients for years and
prove the benefit in life expectancy in real patients, not just in our
statistical simulation,"
Several people who are very large (called "supersized") have stated that they
have outlived both the doctor's dour predictions about their lifespan as
supersized and also have outlived many of their similarly sized friends who
had WLS.
The AMA does offers no guarantees for weight loss surgery:
" Short-term outcomes are
impressive-patients undergoing bariatric surgery maintain more weight loss
compared with diet and exercise. Comorbidities such as type 2 diabetes can be
reversed. But long-term consequences remain uncertain. Issues such as whether
weight loss is maintained and the long-term effects of altering nutrient
absorption remain unresolved."
"The ethical haze surrounding bariatric
procedures is not unknown in surgery, said Laurence B. McCullough, PhD, a
professor of medicine and medical ethics at Baylor College of Medicine in
Houston, Texas."
"This is the classic problem in surgery-innovation without the research to
guide it. So all this should be brought under experimental protocols,"
McCullough said. "That's how you handle the conflict of interest make
sure you tell the patient, 'The procedure is investigational; we don't know if
it will help you."'
1762 JAMA, April 9, 2003-VoL 289, No. 14
From the information we have at present, it
appears that a decision to have weight loss surgery may not be a decision
involving longevity but rather a quality of life decision.
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