Bariatric Surgery: Without Some Pain, Weight Gain

Weight-loss surgery has to historically maintained a negative stigma due to the complications and deaths reported in the small number of cases being performed. Healthcare providers have been frustrated by the non-compliant nature of the obese patient, and one of the obstacles preventing significant penetration of surgical options into the obesity market is this negative stigma. After leaving the physician’s office, patients are left debating their options and the risks associated: 1) undergo surgery and risk near-term surgical complications (possibly death), or 2) no surgery and long-term co-morbid conditions (possibly death). Left with this choice, patients will typically opt for the long-term co-morbid conditions, thus deciding not to have surgery.

Currently, there are numerous studies and R&D efforts focused on erasing this bad image associated to bariatric surgery. In 1998, the in-patient mortality rate post-operation was 0.89%. A decade later, ASMBS showed that from a reported 66,000 cases the mortality rates were 0.31% at 30 days after surgery and 0.38% at 90 days after. The re-operation rate was 2.4%.

In 2007, the most irrefutable data to date was released from a 10-year, 4,047-patient study showing the effects of bariatric surgery on mortality in Swedish obese subjects. With 2,010 patients undergoing bariatric surgery (gastric bypass, vertical-banded gastroplasty, or adjustable gastric banding) and 2,037 using conventional treatment, the results showed that after 10 years there were 101 deaths in the surgery group compared with 129 deaths in the control group. The conclusion of the study was that bariatric surgery for morbidly obese patients is associated with long-term weight loss and a reduced mortality rate.

Endoluminal procedures: going straight for the throat

To further counter the negative stigma surrounding bariatric procedures, device makers are taking the next step in minimally invasive surgery. The next wave of products to be commercialized in the obesity space is likely to include many that utilize endoluminal surgical technology. Accessing the GI tract through the mouth/esophagus is hoped to produce similar results to the current treatment options but with much lower risk of complication. Invasive surgery has many downsides, such as: pain, scarring, recovery time, increased incidence of post-surgical complications, need for general anesthesia, longer procedure times, longer hospital stays, and typically more expense. If proven efficacious, products using endoluminal technology could be a resounding and overall win for the patient, physician, hospital, and device maker on most, if not all counts.

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