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.
Many surgeons answer the longevity question as Dr 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. This is even more odd when one considers that longevity data on the adjustable lap band surgery has already been released and that surgery is barely TEN YEARS OLD.
Dr Paul Ernsberger stated, on a recent Donahue show:
Well, the gold standard in medicine is the controlled clinical trial. We don’t 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 haven’t we seen the final results? I think it’s because it’s bad news.
The ASBS 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 recent study headed by Dr 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".
Many surgeons seem to feel that the ASBS statistics may be incorrect in most cases.
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. This error in stating the cause of death may have skewed the "official" gastric bypass death stats somewhat.
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 10,000
Liposuction : 1 death in 5000
WLS : 1 death in 1000 (at best estimate at www.asbs.org ).
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://gastricbypass.netfirms.com/masonpromvgb.htm
Finally, a recent analysis theorized that a person with a gastric bypass would only gain 3 years of life from it over what they would have lived if they had remained obese and not had surgery. This means whereas a clinically obese person might live as long as a light smoker (age 70), at best estimates, a person who had a gastric bypass might live to the age of 73. (normal lifespan is considered, 75 years)
http://www.lef.org/news/disease/2002/10/31/eng-newsrx/eng-newsrx_093942_6228351458362378163.ew.html
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.
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