Current status of laparoscopic bariatric/metabolic surgery in Japan: The sixth nationwide survey by the Japan Consortium of Obesity and Metabolic Surgery

Abstract

Introduction Laparoscopic bariatric procedures have been performed in Japan since 2000. Laparoscopic sleeve gastrectomy (LSG) has been fully covered by National Health Insurance since 2014, and it has been increasingly performed recently. The Japan Consortium of Obesity and Metabolic Surgery conducts a nationwide survey on laparoscopic bariatric/metabolic surgery every 2 years. Methods The survey was sent by post or email to 97 Japanese institutions in January 2020. Results From 2000 to 2019, a total of 3669 laparoscopic bariatric/metabolic procedures were performed in 64 institutions. The most popular procedure was LSG (n = 2866), followed by LSG with duodenojejunal bypass (LSG‐DJB, n = 337) and laparoscopic Roux‐en‐Y gastric bypass (LRYGB, n = 280). Morbidity and reoperation rates were, respectively, 29.8% and 11.8% for LRYGB, 16.8% and 2.8% for LSG, and 13.6% and 6.6% for LSG‐DJB. At 5 years after the procedures, the percentage of excess weight loss was 78% for LRYGB, 66% for LSG, and 80% for LSG‐DJB. Conclusion This nationwide survey clearly showed that laparoscopic bariatric/metabolic surgery has been safely and effectively performed for 20 years in Japan.

Current Status and Issues Associated with Bariatric and Metabolic Surgeries in Japan

“…According to JCOMS survey, 3669 laparoscopic BMS were conducted during 2000 to 2019. The most popular procedure used was LSG (n = 2866), followed by LSG-DJB (n = 337), LRYGB (n = 280), and LAGB (n = 109), respectively [1] (Fig. 1).…”

“…Up to postoperative 7 years, all procedures resulted in over 50% of excess weight loss (= 100 × (initial weight − postoperative weight)/(initial weight − ideal weight) [ideal BMI of 25 kg/m 2 ]). JCOMS survey also indicates that bypass surgery showed superior results as compared to LSG or LAGB in terms of body weight loss (BWL) [1]. Unfortunately, overall postoperative data regarding the impact of these surgeries on obese-related comorbidities was not available in any national resources.…”

“…In addition, anastomotic-related complications including leakage, stenosis, and marginal ulcers in the earlier days contribute to the higher rate of morbidity and reoperation in LRYGB. With respect to the complications associated with LSG, the rates of postoperative bleeding, leakage, stricture, and gastroesophageal reflux disease (GERD) were 0.7%, 0.5%, 1.1%, and 12.1%, respectively [1].…”

“…1 Annual changes in laparoscopic bariatric and metabolic procedures. Adapted from the 2019 JCOMS survey [1] only for surgical cost, and other hospital charges are covered by NHI. LSG-DJB is one of the HAMTs since 2018 with an estimated cost of $8000.…”

“…LSG with duodenal-jejunal bypass (LSG-DJB) has been acknowledged by the government as a HAMT since 2018. According to a survey by Japan Consortium of Obesity and Metabolic Surgery (JCOMS), 757 cases of laparoscopic BMS were recorded in 2019 [1].…”