LEAKS more VSGs=more leaks ....up to 9% in Europe

I just read this and it looks like the leaks were half in the first few days and the other half 2-4 weeks.  No deaths.  Treatable completely with stents.  Though not a good thing, it sure does beg the question of why their leak rate is so high.  This is why it is critical to go to an experienced surgeon and then follow his instructions to the letter. 

The incidence of leaks was 2.6% in their practice. The incidence of leaks for all VSGs in Germany was 9%. That comes from reference #2: Stroh C, Birk D, Flade-Kuthe R, et al. Results of sleeve gastrectomy-data from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009;19(5):632–640.

The patients with the leaks were all REVISIONs to a VSG from another bariactric surgery. . . . .

These patients always have high complication rates. 

I think that since the VSG is getting so popular many doctors could be jumping in without the sufficient training in this specific procedure.  They see the $$$ and, like some 'plastic surgeons', advertise that they are Sleeve surgeons without going the extra step to become trained in the specific procedure.  Did you know that any surgeon can claim to be a plastic surgeon?  That is why it is up to you to find one that is Board Certified.  It is also up to you to research your Sleeve surgeon and find one with experience.

This "study" shows several problems, ones that were corrected in the US several years back.

1.  If you cut away the stomach too close to the esophagus, you create significant problems.  You also create problems if you get too close to the pylorus.  Obviously, these surgeons were in the "learning curve", and they were somewhat behind their North American fellows.

2.  With the VSG, 2005 is almost ancient history.  The surgery has been refined a lot since then.  Yet this study runs from 2005-2008, with absolutely no breakdown of how many were from each year.  How many of those leaks occurred in 2008 and how many in 2005?  You can't tell from this piece of garbage.

3.  It also does NOT identify what countries these surgeries were done in.  That could be a major defect, did most of these leaks occur in only one area?  You can't tell, it just refers to Europe, which is a rather large place with highly varying medical standards.  There is a huge difference between surgical practices in Romania and Great Britain, as an example.

Just because something is published does not make it a valuable piece of "research".

Thank God for my undergraduate and graduate coursework in "Research Design and Methodology".  They taught us to really look at research papers like this, and figure out if they really mean something.  This particular article, wiile liky somewhat accurate, does not mean very much because it has some really serious and glaring holes in it.

I have to agree with oldmedic on this one. I, too, have a Master's degree and had the dreaded Research and Statistics. I did not read the article but it is true that data can be messed with very easily. My research professor used to disect research studies all the time, even ones in very honorable publications. I have no idea about this study, but from what i have read, it seems there could possibly be lots of holes in it. Need to study it further.

The biggest thing that scares me is I have a lap band. I will be one of those ones with a higher risk of leaks. I think that in and of itself has been more than proven. It stinks!!!!

Just read through the study from which the leak rate of 9% was cited. Found a few interesting things:

First - this was a small study - just 144 patients - who had VSG surgery 2006-2007 in Germany.

Only three of the hospitals included in the study performed more than 10 VSG procdedures/year (So, the surgeons were not that experienced with bariatric VSG surgery).

The article was mis-quoted: they claimed a major complication rate of 9.4% and  leak rate of 7% (still way too high!) in Germany.

Mortality cited as 1.4% - but total mortality was 2 persons and it is questionable to generalize these results when the total number of people in the study is small (144) Both mortalities related to leaks.

Finally, the authors included a table summarizing the literature whi*****ludes 23 studies - includind their own German trial. The leak rates, for these studies, excepting the 7% in the German trial and two case studies of just one patient each,, ranged from 0-4.3. Leak rate was not reported in 7/22 studies - but where it was reported the mean was 1.37%.  AND the total number of leaks was 18/1,936 - again about 1%. Mortality, when reported, for all other studies was 6/2194 ... less than .3%

What I would want to know if I planned to have surgery in Germany is why is the reported leak rate so much higher than in all of the other studies reviewed? (And I have to question the quality of this research since the authors do not express any curiosity about this significant difference in outcome for their sample.)

(I'm doing a PhD now and am immersed in research and statistics courses at the moment - so I couldn't resist tearing into this one a bit..... after all my moment of being torn-into is approaching!.)