COMMENTARY

Bariatric Surgery: Where Are We?

Experts Discuss the Bariatric Landscape in France

Jean-Pierre Marmuse, MD; Boris Hansel, MD

Disclosures

April 21, 2015

In This Article

Editor's Note: The following is an edited, translated transcript of a conversation taped in March 2015 between Boris Hansel, MD, endocrinologist/diabetologist and nutritionist, and Jean-Pierre Marmuse, MD, known as the pioneer of bariatric surgery in France.

A Global Perspective on a Rapidly Growing Treatment

Boris Hansel, MD

Dr Hansel: Bariatric surgery is very much in the scientific news, with new data emerging on its benefits and risks. In France, bariatric surgeries increased from 15,000 in 2006 to 30,000 in 2011—in other words, the number doubled. And this trend has continued, with 42,000 such surgeries performed in 2013.

These figures are somewhat startling. Professor Marmuse, is this getting out of control? Is bariatric surgery as safe as an appendectomy or gallbladder surgery?

Jean-Pierre Marmuse, MD

Dr Marmuse: In France, bariatric surgeries are subject to prior agreement, so we can't operate on a patient—or at least, the surgery won't be covered—without the approval of medical experts. Therefore, in most cases, patients who undergo bariatric surgery in France meet the usual requirements for these procedures, which are based on body mass index (BMI) and associated comorbidities.

As to your second question about safety, these procedures are much more complex and in theory carry a much greater risk than an appendectomy or a cholecystectomy. The risks are roughly equivalent to those associated with a gastrectomy. But once again, in France, bariatric surgery involves referral centers, and with experienced teams at these centers, the mortality rate is in the order of 1 in 1000, which is only slightly higher than that for appendectomies or cholecystectomies. These are, in fact, complex procedures, and—I want to emphasize this—patients should be careful to have surgery done only by experienced teams.

[Editor's note: In the United States, the 30-day mortality rates for sleeve gastrectomy, gastric bypass, and gastric banding are 0.08%, 0.14%, and 0.03%, respectively.[1,2,3] These rates are lower than those typically associated with gallbladder removal or hip replacement surgery.]

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