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Status of surgery in South Korea

Status of bariatric and metabolic surgery in Korea

Growth of bariatric and metabolic surgery reflects worldwide increase in procedures
Adjustable gastric bands were reported to have the largest increase and was the most common bariatric and metabolic procedure

A survey reporting the current status of bariatric and metabolic operations in South Korea has reported that the increase in the numbers of sleeve gastrectomies (SG) and RYGBs in Korea mirror those of worldwide trends. However, unlike the rest of the world, the adjustable gastric band (AGB) were reported to have the largest increase and was the most common bariatric and metabolic procedure. The results for the survey, ‘Nationwide Survey on Bariatric and Metabolic Surgery in Korea: 2003–2013 Result’, were published in SpringerPlus, on behalf of the Information Committee of the Korean Society of Bariatric and Metabolic Surgery.

The survey evaluated the current status from 5,467 (27 university hospital and 5 bariatric centres) bariatric and metabolic operations in the country. The outcomes showed that the annual numbers of operations increased each year, from 139 in 2003, 227 in 2009, 541 in 2010 and 1,686 in 2013.

The most common operation was AGB (n=3,676, 67.2%), followed by SG (n=775, 14.2%), RYGB (n=697, 12.8%) and mini gastric bypass (MGB, n=182, 3.3%). Duodeno-jejunal bypass (DJB, n=52, 1.0%), resectional gastric bypass (n=25, 0.5%), gastric plication (n=10, 0.2%), biliopancreatic diversion (n=1), and biliopancreatic diversion with duodenal switch diversion (n=1).

By year, AGB increased after 2009 and reached 1,210 cases in 2013; RYGB also rose after 2009 to 193 in 2012. Revision or secondary procedures accounted for 2.6% (n =90) of cases with data on primary or revision operation (n=3,460). RYGB was the most used procedure (n=29), then AGB (n=18) and SG (n=12).

According to the authors, the reason why AGB accounted for more than 70% of the procedures performed between 2011 and 2013, is because the relative ease, speed, reversibility of the procedure, and the lack of “anastomosis in AGB meant that private hospitals were more likely to perform AGB.” In addition, more AGB were performed in private hospitals.

For every male that had a procedure, there were 3.5 females who underwent an operation. In total, 66.1% of 3,332 patients had comorbidities with fatty liver (36.8%), (24.0%), hypertension (22.4%), and dyslipidaemia (20.8%) the most common.

Eighty percent of the patients presented with BMI≥30, 53% ≥35 and 25% ≥40. For patients with BMI≥40, AGB (47.4%) was the most common procedure. The most common operation for patients with diabetes was RYGB (31.8%), with AGB the most common operation (65.9%) for non-diabetic patients.

Unsurprisingly, most operations (98.5%) were performed laparoscopically and1.2 % were open procedures. There were nine robotically performed procedures. The mean operation time was 96.8 minutes (Range 30∼720) and the mean hospital stay was 4.6 days (range 1∼386).

The survey reported that the rates of in-hospital morbidity and mortality were 6% (114/2305) and 0.25 % (5/2176), respectively, with wound complication (1.4%) the most common. In total, the morbidity rates after RYGB, SG and AGB were 8%, 7% and 1%, respectively.

“All bariatric and metabolic surgeries could be considered to be safely performed. More follow-up data are needed to evaluate efficacy,” the authors conclude. “These results can be used as baseline data for insurance coverage of metabolic and bariatric surgery and to develop the Korean guidelines and quality control standards. The results can also be used to develop future multicenter collaborative studies.”

To access this paper, please click here

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