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Procedure numbers

Sleeve passes bypass as most performed procedure

SG increased from 6.0 percent in 2008 to 67.3 percent in 2013

Sleeve gastrectomy (SG) surpassed Roux-en-Y gastric bypass (RYGB) in 2012 as the most common procedure performed in Michigan and sleeve also became the predominant bariatric surgery procedure for patients with type 2 diabetes, according to a study published in JAMA.

Changes in procedure use over time reflect emerging evidence regarding the comparative safety and effectiveness of available procedures. An understanding of current trends in bariatric procedure use can inform primary care physicians counselling patients with morbid obesity who are considering surgical intervention, according to background information in the article.

Dr Bradley N Reames from the University of Michigan, Ann Arbor, and colleagues analysed data on 43,732 adults who underwent primary inpatient and outpatient bariatric surgery within the 39-hospital Michigan Bariatric Surgery Collaborative between June 2006 and December 2013.

The researchers found that relative use of SG increased from 6.0 percent of all procedures in 2008 to 67.3 percent of all procedures in 2013, an increase of 61 percent. During the same period, use of RYGB decreased from 58.0 percent to 27.4 percent, and use of laparoscopic adjustable gastric banding decreased from 34.5 percent to 4.6 percent.

Even though SG was the most common procedure across all subgroups in 2012 and 2013, SG rates were relatively lower in patients 65 years or older, in patients with gastro-oesophageal reflux disease, and in patients with type 2 diabetes.

"Although long-term outcomes of SG are still unclear, these changes may reflect the favourable perioperative safety profile and emerging evidence of successful weight loss at 2 to 3 years after SG,” the authors write. “These findings are important to inform primary care physicians of the predominant bariatric procedure currently used, regardless of pre-existing comorbidity, and may assist in the preoperative counselling of patients considering surgical therapy for morbid obesity.”

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