Changing Practice of Laparoscopic Bariatric Surgery in 2 Countries

Introduction: Internationally, operative procedures performed for weight loss differ in type based upon local socioeconomic conditions. The purpose of this study was to examine the practice patterns for bariatric surgeons at a hospital in Cuenca, Ecuador and in Nashville, TN at a major tertiary care institution.

Methods: The personal database of the surgeon in Ecuador (EM) and the Bariatric database for the Vanderbilt Center for Surgical Weight Loss (VCSWL) were examined.

Results: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was performed in 20 patients in Santa Ana Hospital in Cuenca, Ecuador from 2/2003 through 12/2006. From 1/2007 through 6/2008, 28 patients underwent laparoscopic sleeve gastrectomy (LSG). Two patients undergoing LRYGB developed leaks, required laparotomies, and had extended hospitalizations, while none of the LSG patients had major complications.
From 11/2000 through 1/2003 VCSWL performed 153 open RYGB and 126 LRYGB procedures. From 2/2003 through 12/2006 VCSWL performed 769 LRYGB, 342 Open RYGB, 62 hand-assisted LRYGB, and 121 Lap Adjustable Gastric Bands (LAGB).
From 1/2007 through 6/2008 VCSWL performed the following procedures: 240 LRYGB, 5 Open RYGB, 112 LAGB, and 12 LSG. All the Ecuadorian patients paid cash for the operative procedure for both LRYGB and for LSG. In the US all of the patients undergoing LRYGB had insurance coverage, while 16/19 (84%) of the patients undergoing LSG paid cash for their procedure.

Conclusions: Laparoscopic bariatric surgery has replaced open gastric bypass in these 2 centers. Since 2007 most patients in Ecuador or the USA paying cash for the procedure elect to undergo LSG. Choice of bariatric surgical procedure is highly dependent on insurance coverage. Utilization of the LSG is increasing in Ecuador and at VCSWL, particularly in cash pay patients.

Session: Poster

Program Number: P081

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