Obesity Surgery: VA Outcome Study

Weight loss (bariatric) surgery is likely to become increasingly important to address the obesity epidemic in the U.S. and other nations.

There are several types of surgical techniques used for bariatric surgery.

One of the most invasive is the Rous-en-Y gastric bypass (RYG) operation. This operation involves bisection of the small intestine and reattachment of the upper section to a position lower down the small intestine. This provides for a shorter distance for food to be absorbed.

Less invasive techniques using a sleeve (sleeve gastrectomy SB) or adjustable gastric banding (AGB) around the stomach are also common surgical approaches.

A recent large Veterans Administration bariatric surgery outcome study helps in understanding the long-term relative weight loss efficacy of three types of operations. This study compared outcomes between three types of operations (RYGB

The chart I have put together from data abstracted from the manuscript is above. The summary findings include the following key items:

• All three surgical interventions were superior to no operation controls
• All three surgical interventions maintained significant weight loss at five years
• Rous-en-Y (RYB) was superior to SG and AGB at one and five years.
• The study supports about a 30%/20%/10% five year weight reduction for the RYG/SG/AGB operations

I have included a schematic of the RYG procedure from the Wikipedia Commons file here. This schematic has the tranverse colon cut away to show the small intestine re-attachment site.

There are some significant limitations of this study. Surgical procedures were not randomized and study subjects differed on some clinical and demographic features at baseline. VA subjects are predominantly male and results may not be generalizable to women.

There was not a detailed report of risks and complications for each procedure.

Nevertheless, this is an important study that supports use of bariatric surgery as an option in the treatment of high-risk severely obese U.S. veterans.

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Chart above is an original chart produced by me from data abstracted from the manuscript.

Readers can access the manuscript abstract by clicking on the PMID link below

The Wikipedia Commons file was originally uploaded by Topnife at English Wikipedia - Transferred from en.wikipedia to Commons., Attribution, https://commons.wikimedia.org/w/index.php?curid=3153491

Maciejewski ML, Arterburn DE, Van Scoyoc L, Smith VA, Yancy WS Jr, Weidenbacher HJ, Livingston EH, & Olsen MK (2016). Bariatric Surgery and Long-term Durability of Weight Loss. JAMA surgery PMID: 27579793