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08-14-2019 | Article

Editorial board commentary

Author:
John Wilding

Comment on: Bariatric surgery linked to late adverse events

Bariatric surgery is considered a clinical and cost-effective treatment for severe obesity, with many health benefits, including prevention and remission of type 2 diabetes. Modern laparoscopic surgery has reduced the risk for immediate surgical complications, but questions still remain about long-term complications, including surgical complications such as leaks, gallbladder disease, internal hernias and fistulas, but also medical complications including hypoglycemia, and psychological problems such as alcohol abuse.

This retrospective, matched case-control study of nearly 8000 patients from France who underwent either sleeve gastrectomy or Roux-en-Y gastric bypass represents one of the largest contemporary studies of outcomes after bariatric surgery. As it uses health claims data from the French National Health Insurance database, it was possible to capture this information, and also compare it to a control group matched for demographic characteristics.

Although in line with other studies in showing reduced mortality risk in those who had bariatric surgery, it is clear that many patients required further surgery, including for severe complications such as strictures, as well as for gallstones, which commonly develop after rapid weight loss. Severe nutritional disorders, especially iron deficiency, were also more common as were psychiatric disorders including alcohol abuse and suicide.

This may only represent the tip of the iceberg. The data only included hospital admissions so will likely capture severe complications resulting in surgery, but other complications which can be very troublesome for patients including abdominal pain and diarrhoea, less severe nutritional deficiencies and hypoglycemia not requiring hospital admission may well not be accurately recorded. Many patients will regain weight and some will require revisional surgery, which has a higher rate of complications. This emphasizes the importance of lifelong follow up, including nutritional monitoring for everyone who has bariatric surgery. The ongoing By-Band-Sleeve prospective study being conducted in the UK may eventually answer some to the questions about some of these other complications.