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How Safe is Bariatric Surgery?

From Nature Reviews Endocrinology Posted: 12/28/2009; Nat Rev Endocrinol. 2009;5(12):645-646. © 2009 Nature Publishing Group

The Longitudinal Assessment of Bariatric Surgery (LABS) consortium have published the results of their first study, LABS-1, in the New England Journal of Medicine, which indicate that the overall risk of adverse outcomes of bariatric surgical procedures is low.

LABS-1 was a prospective, multicenter study, which measured the 30-day morbidity and mortality of 4,776 patients who underwent one of the three most frequent bariatric surgical procedures performed in the US. The investigators found an overall mortality rate of 0.3% and a major complication rate of 4.1%, both of which are comparable to other major abdominal surgical procedures.

The procedures evaluated in this study included open and laparoscopic Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. The LABS-1 investigators found that the 30-day composite end point of death, major thrombotic complication, reintervention and prolonged hospitalization was 1.0% for laparoscopic adjustable gastric banding, 4.8% for laparoscopic Roux-en-Y gastric bypass surgery, and 7.8% for open Roux-en-Y gastric bypass surgery.

The LABS-1 researchers analyzed data from patients treated by 33 different surgeons at 10 different clinical sites. The procedures analyzed were performed by highly skilled surgeons at high-volume centers of excellence which perform more than 100 Roux-en-y gastric bypasses annually. Previous research, however, has revealed that outcomes of both high-volume and low-volume programs are similar between centers of excellence and centers without said designation. The data analyzed in LABS-1, therefore represents the current state of the art in bariatric surgery and the study provides both surgeons and patients with realistic expectations of postoperative safety of three different bariatric procedures.

It can be concluded that until we begin to see success with primary prevention or develop other equally effective medical management, bariatric surgery will remain an important, and safe, tool in our armamentarium for the treatment of obesity.

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