DATE
XXXX XXXXX, MD
Medical Director
FULL ADDRESS
Dear Dr. XXXX XXXXX
Laparoscopic Sleeve Gastrectomy has been increasing its popularity as a primary bariatric surgery treatment for morbid obesity. So much so that a new CPT code – 43775, Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) has been established by the AMA and CMS.
As a practicing bariatric surgeon and member of the American Society for Metabolic and Bariatric Surgery, AmericanCollege of Surgeons and President of the XXXXX State Bariatric Surgery Society, I would like to take this opportunity to share with you some key results that have been recently published regarding Sleeve Gastrectomy.
Obesity related diseases are ameliorated with substantial weight loss[1],[2],[3] and sleeve gastrectomy has shown in a randomized control trial (RCT)[4] to have greater weight loss at three years than adjustable gastric banding, a covered bariatric surgery procedure. Another RCT[5] and one case matched control study [6] compared sleeve gastrectomy to Roux en Y gastric bypass (a covered bariatric procedure) and found there was not a statistical difference in weight loss at one year. Other comparative cohort studies[7],[8],[9] show similar results. Corresponding reductions in obesity related comorbid conditions are also reported6,[10],[11]
Including sleeve gastrectomy as a treatment option for morbid obesity will not necessarily increase the risk to the patient population. A recent systematic review10and large registry11 showed perioperative mortality rates of 0.19% and 0.36%, respectively, which is not substantially different from other mortality rates reported for other bariatric surgery procedures ranging from 0.30% in a national NIH sponsored registry[12] to 0.55% in a recent meta-analysis[13]. Similarly, sleeve gastrectomy does not appear to have an increase risk of reoperation, perioperative bleeding or gastric leaks10 compared to other bariatric procedures[14].
Sleeve gastrectomy may offer advantages to patients with specific medical conditions such as chronic NSAID use; those that have had prior surgery or those with a large ventral hernia, to name a few. The sleeve gastrectomy procedure leaves a continuous gastrointestinal tract resulting in a functional pylorus and duodenum while not implanting a device that requires considerable follow up visits or may need to be removed or replaced.
We urge you to add laparoscopic sleeve gastrectomy as a covered procedure in the treatment of morbid obesity. We would welcome the opportunity to discuss this further with you. Please use the contact information below to arrange a call or meeting.
Respectfully yours,
[1] Tice et al.Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008 Oct;121(10):885-93.
[2] Cottam et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up.Obes Surg. 2006 May;16(5):534-40.
[3] Batsis et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study.Mayo Clin Proc. 2008 Aug;83(8):897-907.
[4]Himpens et al. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006;16:1450–6.
[5]Karamanakos et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008;247:401–7.
[6]Vidal et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects. Obes Surg 2008;18:1077– 82.
[7]Lee et al. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007;21:1810–6
[8]Strain et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009 Sep-Oct;5(5):582-7. Epub 2009 Apr 14.
[9]Wong et al. Laparoscopic bariatric surgery: a five-year review. Hong Kong Med J. 2009 Apr;15(2):100-9.
[10]Brethauer et al Systematic review of sleeve gastrectomy as staging and primary bariatric procedure SOARD 2009;5;469-475
[11]Sanchez-Santos et al. Short- and Mid-term Outcomes of Sleeve Gastrectomy for Morbid Obesity: The Experience of the Spanish National Registry, Obes Surg 2009;19 :1203–1210
[12] Longitudinal Assessment of Bariatric Surgery (LABS) Consortium et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009 Jul 30;361(5):445-54.
[13] Buckwald et al. Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292:1724-1737.
[14]Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142:547-559