Original Title: Tratamiento Quirúrgico de la Obesidad Mórbida

Authors' objectives: 1. Analyse the activity and degree of implementation of bariatric surgical techniques in the Spanish national health system. 2. Assess its efficiency, effectiveness and safety while making basic recommendations to guarantee the quality of the care provided.

Authors' results and conclusions: Of the survey: A total of 88 questionnaires were sent to health centres that perform bariatric surgery. 67% corresponded to public centres and 33% to private centres. The overall response rate was 51.1%. In Spain, this technique has been used since 1977. Bariatric surgery is applied in 15 autonomous communities. All the techniques are used, although gastric bypass is the most widely used technique at this time and is employed in 82% of health centres. Of the review: A summary has been made of the results obtained from 5 systematic reviews (which include 273 studies) and 29 primary studies. With regard to reliability, the morbidity attributable to adjustable gastric banding and vertical banded gastroplasty (VBG) stands at about 10%, with high re-operation rates in the medium and long term, due both to the failure of the technique (effectiveness), and to complications experienced with this technique or major repercussions on the quality of life of the patient. The Gastric Bypass (GB) presents an overall rate of perioperative death of under 1%, and pulmonary thromboembolism and sepsis due to suture dehiscence are the most common causes. With regard to effectiveness, short-term weight loss is similar in all techniques. But the maintenance of weight loss in the medium to long term is lower in the case of restrictive techniques and partial weight recovery is observed. VBG achieves losses of excess weight of between 55% and 60% over a five-year period, while patients subjected to GB lose 60-70% and about 75% after the BPD.

Authors' recommendations: Due to methodological and design problems, the scientific evidence is moderate to low and therefore the results must be taken with precaution. Overall, simple (restrictive) surgical techniques imply high levels of reliability and lower effectiveness in the long-term. On the other hand, the greater the malabsorptive component, the higher the risk of complications, the more difficult the learning curve and the better the results with regard to weight loss.

Authors' methods: 1. A survey of 88 public and private health centres that carry out or have carried out bariatric surgery within the national health system and search of records and databases on hospital activity in order to determine the level of implementation of this technique in Spain. 2. Systematic review of the safety and effectiveness of surgical techniques for patients with morbid obesity in terms of weight loss, improvement in comorbidities, quality of life, mortality and complications. The search was electronic and manual in the following languages: Spanish, English, French and Italian during the period 1992 to 2002.

Project Status: Completed

Year Published: 2004

URL for published report: https://www.euskadi.eus/contenidos/informacion/2004_osteba_publicacion/es_def/adjuntos/2004/d_04-01_cirugia_obesidad_morbida.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>