Dramatic Increase In Annual Rate Of Laparoscopic Bariatric Surgeries, USA

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The number of bariatric surgeries performed in the U.S. increased by 450 percent between 1998 and 2002, a growth the researchers say could be linked with use of the minimally invasive laparoscopic technique, according to an article in the December issue of Archives of Surgery, one of the JAMA/Archives journals.

Currently, surgery is the only effective sustained weight loss option for patients with morbid obesity, according to background information in the article. "The increased enthusiasm for bariatric surgery coincides with the development and dissemination of the laparoscopic approach to bariatric surgery," the authors write. The American Society for Bariatric Surgery (ASBS) estimated that approximately 140,000 bariatric procedures would be performed in 2004.

Ninh T. Nguyen, M.D., and colleagues from the University of California, Irvine Medical Center, Orange, evaluated Nationwide Inpatient Sample (NIS) data for patients who underwent bariatric surgery for the treatment of morbid obesity from 1998 through 2002 to see if the recent growth in bariatric operations correlated with the widespread use of laparoscopic bariatric surgery.

Between 1998 and 2002, the number of bariatric operations performed in the U.S. increased by 450 percent, from 12,775 to 70,256 cases. Most of the bariatric operations consisted of Roux-en-Y gastric bypass, which increased from 78 percent of bariatric surgeries in 1998 to 92 percent in 2002. Laparoscopic bariatric surgery also increased, from 2.1 percent to 17.9 percent of bariatric surgeries from 1998 to 2002. The number of institutions that perform bariatric surgery increased from 131 to 323. The researchers also saw an increase in the number of bariatric surgeons with membership in the American Society for Bariatric Surgery, from 258 to 631 members.

"Although most patients currently seeking bariatric surgery are requesting the laparoscopic approach, not all patients qualify for the laparoscopic technique and not all surgeons are comfortable with performing laparoscopic bariatric surgery," the authors note. "Other factors probably contribute to the growth of bariatric surgery," the authors add. "The medical community now recognizes that morbid obesity is a chronic illness and that surgery can substantially reduce obesity-related illnesses and improve one's quality of life."

In conclusion the authors write: "The observed increase in bariatric surgery rates is related in part to an increase in utilization of the laparoscopic technique by surgeons and greater acceptance by patients of the minimally invasive option," the authors write. "Without a long-term, effective non-surgical treatment for morbid obesity on the horizon, the rate of bariatric surgery will continue to increase and the procedure will become on of the most commonly performed gastrointestinal operations."

(Arch Surg. 2005; 140: 1198 - 1202.)
Tom Vasich, JAMA and Archives Journals, www.jamamedia.org

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