International Bariatric Surgery Registry (IBSR)
For Optimum Care of
Morbid Obesity Surgery Patients
| Bariatric Surgery information International Bariatric Surgery Registry (IBSR) |
For Optimum Care of |
Guide to Weight Loss Surgery - Research Into Gastric Reduction Surgery |
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The International Bariatric Surgery Registry (IBSR) The purpose of the International bariatric Surgery Registry (IBSR), formerly known as the National Bariatric Surgery Registry (NBSR), is to promote optimum care of patients undergoing surgical treatment of morbid obesity. Development of the centralized IBSR data base has provided standardized clinical data collection and analysis for the surgical treatment of obesity. One goal of the IBSR is to enable bariatric surgeons to evaluate and improve his/her expertise and benefit from the combined experience of all participants. In 1997, the IBSR published 10 year results.(37) Males comprised 13% of 14,641 patient records in the data set. Mean age at operation was 37± 9.4 years. Operative weight was 127 ± 27.4 kilograms and the Body Mass Index was 46 ± 8.3 kg/m2. Vertical Banded Gastroplasty (VBG) was the most frequently reported bariatric procedure performed (36.3%). VBG was followed by the Roux-en-Y Gastric Bypass (RGB) with 29.5%; Silastic Ring Gastroplasty was 9.9%; and Distal Roux-en-Y gastric Bypass (DRGB) 9.0%. The remaining 15.3% of the procedures were grouped according to the degree of operative complexity. An increase in variation and complexity of procedures was noted in the last quarter of the decade which began January 1, 1986 A subset of records with complete information for perioperative complications and postoperative hospital stay was analyzed for dominant complication. Mean postoperative hospital stay was reported to be 4.7 days (±2.7). Within 30 days of operation, no perioperative complications were reported for 93.37% of the patients. Major (1.35%) and minor (5.28%) perioperative complications were defined according to length of postoperative stay. Twenty-five deaths were reported to have occurred within 30 days of operation, for an operative mortality rate of 0.17%. Pulmonary embolism was the most frequent reported cause of operative death (n=9) Risk and efficacy of operations for obesity must be understood in the context that morbid obesity is a chronic, frequently progressive, life threatening disease. The therapeutic program applied should be designed to last throughout the lifetime of the patient. Adequate long term follow-up is essential before additional measures of treatment effectiveness can be reported. Weight Loss Results Weight loss usually reaches a maximum between 18 and 24 months postoperatively. Mean percent excess weight loss at five years ranged from 48 to 74 % after gastric bypass and from 50 to 60% after vertical banded gastroplasty. In a study of over 600 patients following gastric bypass, with 96% follow-up, mean percent excess weight loss still exceeds 50% fourteen years. Another 10 year follow-up series from the University of Virginia reports weight loss of 60% of excess weight at 5 years and in the mid 50's between years 6 and 10. Multiple other authors have reported 5 and 6 year follow-up of their patient series with similar weight loss results. Improvements in Comorbidity Factors Weight reduction surgery has been reported to improve several comorbid conditions such as glucose intolerance and frank diabetes mellitus, sleep apnea and obesity associated hypoventilation, hypertension, and serum lipid abnormalities. A recent study showed that Type II diabetics treated medically had a mortality rate three times that of a comparable group who underwent gastric bypass surgery. Also preliminary data indicate improved heart function with decreased ventricular wall thickness and decreased chamber size with sustained weight loss. Other benefits observed in some patients after surgical treatment include improved mobility and stamina. Many patients note a better mood, self esteem, interpersonal effectiveness, and an enhanced quality of life. They have lessened self consciousness. They are able to explore social and vocational activities formerly inaccessible to them. Self body image disparagement decreases. Marital satisfaction increases, but only if a measure of satisfaction existed before surgery. If marital discord exists preoperatively, the improved self image may lead to divorce postoperatively. Surgical Complications Evolving surgical techniques have resulted in progressive improvement in both the safety and long term integrity of bariatric surgical procedures. Previous reports of staple line failures of 15% or more in ten years has resulted in increasing use of gastric transection. In consequence, the need for revisional surgery to correct this problem has all but disappeared. Source: Stomach Bypass Surgery Information |