Longevity (Lifespan) after gastric bypass - some expert opinions and studies

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When asking about how long you live after WLS, the common answer for the lack of either long term patients or studies showing longevity is that the older procedures are not done any more and the newer procedures are too new for that type of evidence.  Any surgeon that I have asked, does not know any patients over 10 years post op.

Many surgeons answer the longevity question as Dr Alan Wittgrove of the Alvarado Clinic did in the online interviews at the time of Carnie Wilson's gastric bypass:

Question: Dr. Wittgrove, I really need to know about how this surgery will effect me when I am old (70, 80 and 90's)

Dr. Alan Wittgrove:

Hopefully you will live that long..... People who are morbidly obese don't have long life spans...

Ideal body weight tables were based on actuarial data....

It is commonly known that people who are morbidly obese die earlier than those who are not morbidly obese.

The bottom line is no one seems to know.  It's likely true that some longer term patients have merged with the general population and do not identify themselves as patients.  To what extent this is true is again, unknown.

The survival rate for the Billroth II, a surgery which is similar to the gastric bypass (but leaves more of the stomach so may be less risky), was an average of 20-25 years.  I have seen Billroth II patients live 40 years after surgery but not without serious health issues.

It is thought that some surgeons are keeping track of patients on a longer term basis.  But to date, little to no longevity data has been released on the gastric bypass surgery despite the fact that it's been done for 40 years. 

Dr Paul Ernsberger, Associate Professor of Nutrition at Case Western Medical School, stated, on a Donahue show:

 Well, the gold standard in medicine is the controlled clinical trial. We donít go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors.  A number of trials have been started, and the final results have never been reported. We have to ask, you know, why havenít we seen the final results? I think itís because itís bad news.

The ASMBS will tell you that the immediate death rate from bariatric surgery is 1 individual for every 1000 surgeries.  This seems be different depending on which surgeon you talk to.  For example, Pories in Sabiston's Manual On Surgery, medical school text book, stated the death rate as 1 in 100, a percentage which other surgeons have agreed with.  Dr Flancbaum feels the death rate is about 1 in 200 surgeries. 

A study headed by Dr David Flum in Washington which analyzed the case histories of 62,000 gastric bypass patients, found that within the first 30 days after surgery, the death rate had been 1 death every 50 surgeries.  This was considerably higher than even the worst estimate.  Dr Flum commented on CNN news that it was time for "a reality check on this surgery".  report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]

The difference between the ASMBS figures and those found in the David Flum study, may be that many gastric bypass deaths are not attributed to gastric bypass but rather to other reasons.

In the Fresno Bee investigation (Fresno, CA, 2001), it was discovered that 27 deaths directly linkable to gastric bypass surgery in the last three months of 2001, were recorded as deaths from other causes.   

A three-month Fresno Bee investigation reviewed death certificates, hospital data and lawsuits to determine the number of area deaths following gastric bypass surgery. The exact number of fatalities is hard to pin down. Death certificates don't always cite gastric bypass as the cause of death, but instead often attribute the death to complications such as heart attacks, blood clots or morbid obesity.

But even at the optimistic, 1 death in 1000 surgeries, gastric bypass surgery is much more risky than other types of surgeries like a hysterectomy.  One reason often given to prospective patients for the higher risks is that bariatric surgery, in general is done on a higher risk population (obese people).  While there is some truth in this, note in the comparison below that the adjustable lap band surgery, done on the same population as the gastric bypass surgery, has a MUCH lower death rate:

Table death rates (death after surgery or within 3 days of surgery):

Hysterectomy: 1 death in 100,000

Adjustable Lap Band: 1 - 3 deaths in 7000

Liposuction  : 1 death in 5000

gastric bypass: 1 death in 50  (Dr David Flum study of 62,000 gastric bypass patients ).

What about long term complications possibly leading to death?

The Mayo Clinic study in 2000 on gastric bypass reported that 20-25 percent of the patients had developed life threatening complications within five years.  Those are similar odds to the medication, Phen-Fen which was considered risky enough to take off the market.

But the rate of life threatening complications may be even higher:

"The American Society of Bariatric Surgery says weight loss surgeries have increased from about 20,000 in 1995 to an estimated 45,000 in 2001. It estimates a 7 percent complication rate.

"But Livingston's own study of 800 patients found complication rates of 20 to 40 percent, with everything from intestinal leaks to nutritional deficiencies. "
ABC News story, March 2001

Edward Mason, inventor of the gastric bypass wrote this in an article in 1999:

"For the vast majority of patients today, there is no operation that will control weight to a "normal" level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity." Edward Mason (MD, PhD - inventor of the gastric bypass)

http://obesitysurgery-info.com/masonpromvgb.htm

 

Dr Terry Simpson commented about the RNY (gastric bypass):

"The RNY trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis." (Dr Terry Simpson, MD, WLS surgeon)

The Dartmouth-Hitchcock study ran a statistical analysis and concluded that gastric bypass patients who kept their weight off might live 3 years longer than obese people.  However about this study, Dr Pope warned:

"The data from the study may be something obese patients can look at and realize that their life could be extended by this operation, but I don't think they can definitively bank on the data. This study needs to be confirmed by long-term prospective studies that follow patients for years and prove the benefit in life expectancy in real patients, not just in our statistical simulation," 
 

Several people who are very large (called "supersized") have stated that they have outlived both the doctor's dour predictions about their lifespan as supersized and also have outlived many of their similarly sized friends who had WLS.

The AMA does offers no guarantees for weight loss surgery:

" Short-term outcomes are impressive-patients undergoing bariatric surgery maintain more weight loss compared with diet and exercise. Comorbidities such as type 2 diabetes can be reversed. But long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."

"The ethical haze surrounding bariatric procedures is not unknown in surgery, said Laurence B. McCullough, PhD, a professor of medicine and medical ethics at Baylor College of Medicine in Houston, Texas."

"This is the classic problem in surgery-innovation without the research to guide it. So all this should be brought under experimental protocols," McCullough said. "That's how you handle the conflict of interest make sure you tell the patient, 'The procedure is investigational; we don't know if it will help you."'

1762 JAMA, April 9, 2003-VoL 289, No. 14

From the information we have at present, it appears that a decision to have weight loss surgery may not be a decision involving longevity but rather a quality of life decision.