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Recommendations of Blue Cross and Blue Shield Association Medical Advisory Panel on Newer Laparoscope-Assisted Bariatric Surgical Techniques

As to whether new bariatric procedures like laparoscopic gastric bypass or laparoscopic gastric banding improve patient outcomes as compared to open gastric bypass, and whether variations on gastric bypass improve outcomes for patients with super-obesity, the Blue Cross and Blue Shield Association Medical Advisory Panel made the following judgments about whether newer approaches to bariatric surgery meet the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria.

1. The technology must have final approval from the appropriate governmental regulatory bodies.

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.

The evidence is not sufficient to form conclusions about the relative efficacy and morbidity of less-invasive approaches to bariatric surgery, specifically laparoscopic gastric bypass and laparoscopic gastric banding. The evidence allows crude comparisons of weight loss outcomes between procedures at 1 year, but is not sufficiently robust to make meaningful comparisons at longer time intervals. The evidence is also not adequate to determine comparative rates of adverse events.

For laparoscopic gastric bypass, the available evidence suggests that weight loss outcomes are similar to open gastric bypass at 1 year. Because of the technical complexity of this operation, there is concern for short-term complications such as anastomotic leaks. Leakage of intestinal contents causes peritonitis, which can be life threatening and usually requires reoperation. The comparative rates of these serious adverse events cannot be determined from the data, leaving considerable uncertainty as to the relative safety of laparoscopic bypass. There are very little data on outcomes longer than 1 year for this procedure.

For laparoscopic gastric banding, the available evidence suggests that weight loss at 1 year is less than that achieved with gastric bypass. More limited evidence on 3-year weight loss suggests that this difference in weight loss may lessen over time. Early adverse event rates are low following laparoscopic gastric banding, and are probably lower than gastric bypass. There is a higher rate of long-term adverse events, and there are a number of potentially serious long-term adverse events such as band slippage or erosion. The available data are not sufficient to determine the rates of these longer-term adverse events with confidence.

There are limited data on outcomes of bilio-pancreatic diversion and/or long-limb gastric bypass for patients with super-obesity. There are no high-quality comparative trials and only limited clinical series data for these indications. These limited data do not establish that these or other variants (e.g., duodenal switch) have any additional benefit for patients with super-obesity, as compared to gastric bypass.

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives.

There is insufficient evidence to conclude whether these procedures (i.e., laparoscopic gastric bypass, laparoscopic gastric banding, bilio-pancreatic diversion, long-limb gastric bypass) either improve the net health outcome or whether they are as beneficial as current established surgery, open gastric bypass with Roux-en-Y anastomosis.

5. The improvement must be attainable outside the investigational settings.

Whether these procedures (i.e., laparoscopic gastric bypass, laparoscopic gastric banding, bilio-pancreatic diversion, long-limb gastric bypass) improve health outcomes has not been demonstrated in the investigational setting.


Based on the above, laparoscopic gastric bypass, laparoscopic gastric banding, bilio-pancreatic diversion, or long-limb gastric bypass do not meet the TEC criteria.

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Blue Cross Blue Shield Association Assessment Program Volume 18, No. 10, September 2003

Bariatric Surgery

Asymptomatic Liver Disease Gastric Bypass - Gastric Bypass Surgery Bone Mass - Bypass Surgery Cures Diabetes - Calorie Intake Roux-en-Y Gastric Bypass Surgery - Duodenal Switch Bypass - Eating Disorders After Bypass - How Effective is Gastric Bypass - Gastric Bypass Revision - Roux-en-Y Gastric Bypass Issues - Risks of Gastric Bypass - Predictors Complications Gastric Bypass - Vertical Banded Operation Decline - Silastic Ring Vertical Banded Gastroplasty - Hyperhomocysteinemia Gastroplasty - Nerve Damage Stomach Stapling - Laparoscopic Adjustable Gastric Banding Quality Life - Long-Term Results Gastric Banding - Topiramate Gastric Banding - Pouch Dilatation Gastric Banding - New Techniques Bariatric Surgery - Newer Bariatric Surgical Techniques - Extreme Obesity Gastric Bypass - Laparoscopic Gastric Banding Day Surgery - Laparoscopy Gastric Banding Problems - Laparoscopic Distal Gastric Preservation - Laparoscopic Gastrectomy - Laparoscopic Gastric Banding - Laparoscopic Gastric Banding Older Patients - Laparoscopic Mini Gastric Bypass - Laparoscopic Roux-en-Y Gastric Outcomes - Laparoscopic Roux-En-Y Safety - Laparoscopic Weight Loss Surgery - Complications Laparoscopic Surgery - Ketorolac Anaesthesia Bariatric Surgery - Health Improvements Bariatric Surgery - Complications Weight Loss Surgery - Benefits Bariatric Surgery - Benefits Weight Loss Surgery - Bypass Surgery Diabetes - Gastric Banding Cardiovascular - Effects Bypass Surgery Diabetes - Endoscopic Intraluminal Sutures - Infections Abdominal Surgery - Endothelial Function Inflammation - Macrophage Inhibitory Factor Levels - Bariatric Surgery Musculoskeletal Complaints - Obesity Surgery Metabolic Syndrome - Bariatric Surgery Metabolic Syndrome - Pre-Operative Bacterial Treatment - Helicobacter Pylori Weight Loss Surgery - Vertical Banded Gastroplasty Roux-en-Y - Nutrient Deficiencies Bariatric Surgery - Folate Deficiency Gastric Bypass Surgery - Iron Deficiency Gastric Bypass - Vitamin B12 Gastric Bypass Surgery - Nutritional Status Vertical Banded Gastroplasty - Nutritional Consequences Gastric Restrictive Surgery - International Bariatric Surgery Registry - Attitudes Bariatric Surgeons - Cost-Effectiveness Gastric Bypass - Weight Loss Surgery UK - Weight Loss Surgery Wisconsin - Medicare Weight Loss Surgery - Childbearing Weight Loss Surgery - Bariatric Surgery Severely Overweight Adolescents - Bariatric Surgery Older Patients - Bariatric Surgery Mortality - Weight Loss Surgery Effects - Office-Based Surgery - Gastric Banding Ghrelint - Ghrelin Levels Gastric Bypass - Roux-en-Y Gastric Bypass Ghrelin - Group Therapy Gastric Bypass - Obesity Surgery Weight Reduction - Bariatric Surgery Adolescents - Peripheral Neuropathy Bariatric Surgery - Personality Weight Loss Surgery - Pre-Surgery Bariatric Surgery - Pre-Operative Intragastric Balloon - Pre-Operative Psychological Testing Bariatric Operation - Psychosocial Variables Weight Loss Surgery - Radiological Gastroenteric Studies - Regulation Obesity Surgery - Tummy Tuck Men - Body Contouring Surgeries After Weight Loss - Total Body Lift Weight Loss - Apronectomy Liposuction Metabolism - Brachioplasty Arm - Panniculectomy Obesity Surgery - Panniculectomy Results - Large Volume Liposuction - Large Volume Ultrasound Liposuction - Lipoplasty Abdominoplasty - Liposuction Surgery Visceral Fat - Liposuction Diabetes Prevention - Is Liposuction Safe - Articaine Hydrochloride Liposuction - Tumescent Liposuction - Ultrasound-Assisted Liposuction - Circumferential Para-Axillary Superficial Tumescent (CAST) Lipoplasty


What Is Weight Loss Surgery | Gastric Surgery - How to Qualify | Types Of Weight Loss Surgery | How Bariatric Surgery Works | Laparoscopy | How Effective Is Surgery | Success Rates | Health Benefits | Complications | Weight Loss Surgery Costs | Find Weight Loss Surgeon | Support Groups | Malabsorption | Gastric Bypass | Biliopancreatic Diversion Bypass | Biliopancreatic Details | Biliopancreatic Benefits/ Biliopancreatic Risks | Duodenal Switch Bypass | Duodenal Switch Details | Duodenal Switch Benefits/ Duodenal Switch Risks | Roux-en-Y Bypass Laparoscopic | Roux-en-Y Bypass Open Surgery | Roux-en-Y Gastric Bypass Benefits/ Gastric Bypass Risks | Roux-en-Y Details | Fobi Pouch Gastric Bypass | Fobi Pouch Benefits/ Fobi Pouch Risks | Dumping Syndrome | How Dumping Occurs | Bypass Health Dangers | Diet After Gastric Bypass | Restrictive Procedures | Gastric Banding | Adjustable Gastric Banding | Lap Band Procedure | Lap Band Details | Lap Band Risks & Benefits | Silastic Gastric Ring Surgery | Gastroplasty | Vertical Banded Gastroplasty | Gastric Surgery | Gastric Stapling | Stomach Stapling | Benefits of Gastric Stapling | Obesity Condition | Obesity Mortality Rate | Obesity Health Risks | Obesity Surgical Treatment | Surgery For Morbid Obesity | Weight-Related Health Risks | Obesity Surgery Research | Bariatric Studies | Gastric Reduction Articles | Weight Loss Surgery Statistics | Stomach Bypass | Stomach Banding | Stomach Gastroplasty | Laparoscopy | Weight Loss Surgery Health Complications | Nutrition after Bypass | Weight Loss Surgery Psychosocial Factors | Gastric Reduction Surgery | Weight Loss Surgery Clinics | Plastic Surgery | Plastic Surgery After Weight Loss | Tummy Tuck/Abdominoplasty | Dermolipectomy | Body Lift | Gynecomastia Enlarged Male Breast | Panniculectomy | Thigh Lift | Cost of Plastic Surgery | Plastic Surgery Information | Cosmetic Surgery | Lipoplasty | Liposuction Types | Health Risks of Liposuction | Tumescent Method | Liposuction Butt | Liposuction Inner Thighs | Liposuction Front Thighs | Cost of Liposuction | Information About Lipoplasty

Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2018 Bariatric-Surgery.Info - Terms - Contact - Information - Resources