Surgery News - August 2008 - (Page 10) 10 GENERAL SURGERY SURGERY NEWS • A U G U S T 2 0 0 8 30-Day Outcomes Favor Gastric Banding Over Bypass B Y J E F F E VA N S Else vier Global Medical Ne ws P H I L A D E L P H I A — Laparoscopic adjustable gastric banding results in a significantly lower rate of major complications at 30 days than does laparoscopic Roux-enY gastric bypass, although both procedures have lower rates of death and fewer major complications than does open Roux-en-Y gastric bypass, according to a large multicenter study. The analysis of 6,953 bariatric surgery patients at 121 academic and community hospitals in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) is the largest to use CPT codes to compare 30day outcomes of each procedure since the codes became available. “Previous comparisons have been limited by small numbers, single-institution studies, or the use of administrative data that have a lack of appropriate CPT codes to compare these adequately,” said Dr. Robert T. Lancaster, who reported on the NSQIP data at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. “The introduction of these codes made multi-institutional comparisons less difficult.” CPT codes became available for laparoscopic Roux-en-Y gastric bypass (RYGB) in 2005 and for laparoscopic adjustable gastric banding (LAGB) in 2006. Dr. Lancaster of the department of surgery at Massachusetts General Hospital, Boston, presented NSQIP data for 4,631 patients who underwent laparoscopic RYGB 3% commodities allocation NEW FUND ALLOCATION A 3% commodities allocation has been added to SDIF in an effort to further align its asset allocation with that of the ACS endowment. The commodities component allows SDIF shareholders to obtain exposure to various types of commodities, including industrial and precious metals, agriculture, livestock and energy. Commodities exposure adds an asset class to SDIF that provides further diversification, and one that historically has a negative correlation to stocks and bonds. For more information about SDIF, please contact Tom Kiley at 312/202-5019, tkiley@facs.org, or Savi Pai at 312/202-5056, spai@facs.org. An investor should consider the charges, risks, expenses and investment objective carefully before investing. For more information or for a free copy of the prospectus, please download a copy at www.surgeonsfund.com or call 1-800-208-6070 and a copy will be mailed to you. Read the prospectus carefully before you invest or send money. SDIF is distributed by Ultimus Fund Distributors, LLC, 225 Pictoria Dr., Suite 450, Cincinnati, OH 45246. The phone number is 513-587-3400. and for 1,146 patients who underwent open RYGB during 2005-2006. He also compared 2006 NSQIP data for 3,580 laparoscopic RYGB patients with those data from 1,176 LAGB patients. The majority of patients were white women in their 40s. At 30 days, mortality was significantly lower among laparoscopic RYGB than open RYGB patients (0.17% vs. 0.79%). Open RYGB patients had a significantly higher rate of major complications at 30 days than did laparoscopic RYGB patients after adjustment for risk factors (7.4% vs. 3.4%, odds ratio of 2.04). Of 19 complications that the investigators analyzed, 13 occurred more often among open RYGB patients, especially wound-related complications and infection. No complication occurred more frequently in laparoscopic RYGB patients than in open RYGB patients. Although mortalMortality was significantly lower ity rates at 30 days were similar for in laparoscopic LAGB and laparothan open RYGB scopic RYGB (0.09% patients (0.17% vs. 0.14%, respecvs. 0.79%). tively), a significantDR. LANCASTER ly lower percentage of LAGB patients developed major complications by 30 days than did laparoscopic RYGB patients after adjustment for risk factors (1% vs. 3.3%, odds ratio of 0.29). The majority of complications occurred with equal frequency in both LAGB and laparoscopic RYGB patients, except for a higher frequency of pneumonia, urinary tract infection, bleeding complications, and pulmonary embolism among laparoscopic RYGB patients. All wound-related complications occurred at similar rates in both groups. “The take-home message here is not that laparoscopic gastric bypass should be preferred to open gastric bypass for all comers. Instead, the clinical scenario as well as the surgeon’s experience and skill set should be used to make that decision. But what that does mean is that, when it’s feasible, the laparoscopic gastric bypass should be preferred over open Roux-en-Y gastric bypass because of its more acceptable 30day safety profile,” said Dr. Lancaster, who had no relevant conflicts of interest. Many studies have demonstrated the benefit of laparoscopic gastric bypass surgery to open gastric bypass surgery—a finding that this study confirms, said Dr. Myriam Curet, who commented on the study. The investigators also found lower rates for selected complications with LAGB—a result that echoes those of other, small studies. However, they did not study postoperative complications such as band slippage, band erosion, band infection, or the need for reoperations, she noted. “A number of authors have found these complications to be sufficiently high in LAGB patients to make overall complication rates similar between LAGB and laparoscopic gastric bypass surgery,” said Dr. Curet, an ACS Fellow and professor of surgery at Stanford (Calif.) University. ■ http://www.surgeonsfund.com http://www.surgeonsfund.com
Table of Contents Feed for the Digital Edition of Surgery News - August 2008 Surgery News - August 2008 Contents The 20/20 Vision: Making Amends News From the College: Dedicated Effort Opinion: NOTESworthy? Pediatric Surgery: Burn Remedy Surgery News - August 2008 Surgery News - August 2008 - Contents (Page 1) Surgery News - August 2008 - Contents (Page 2) Surgery News - August 2008 - Contents (Page 3) Surgery News - August 2008 - Contents (Page 4) Surgery News - August 2008 - Contents (Page 5) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 6) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 7) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 8) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 9) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 10) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 11) Surgery News - August 2008 - Opinion: NOTESworthy? (Page 12) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 13) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 14) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 15) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 16)
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