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Medicine â€ș Surgery

Bariatric Surgery and Outcomes

Works Count: 50225

Description

This cluster of papers focuses on the effects of bariatric surgery on obesity, diabetes, and associated health outcomes. It covers topics such as weight loss, cardiovascular risk factors, metabolic surgery, and long-term impact on diabetes control. The research also delves into lifestyle interventions and the relationship between bariatric surgery and mortality rates.

Keywords

Bariatric Surgery; Obesity; Diabetes; Metabolic Surgery; Weight Loss; Cardiovascular Risk; Lifestyle Intervention; Type 2 Diabetes; Gastric Bypass; Health Outcomes

Gastric Bypass in Obesity

1967-12-01
Edward E. Mason , Chikashi Ito

Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

2009-07-29
David Reed Flum , Steven H. Belle , Wendy C. King +7 more
To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization.
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Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial

2015-09-01
Geltrude Mingrone , Simona Panunzi , Andrea De Gaetano +6 more

Early Experience with Two-Stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-Super Obese Patient

2003-12-01
J.P. Regan , William B. Inabnet , Michel Gagner +1 more

Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications

2014-06-10
Lars Sjöström , Markku Peltonen , Peter Jacobson +7 more
Short-term studies show that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known.To determine the long-term diabetes remission rates and the cumulative 
 Short-term studies show that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known.To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery.The Swedish Obese Subjects (SOS) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden. Of patients recruited between September 1, 1987, and January 31, 2001, 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline. For the current analysis, diabetes status was determined at SOS health examinations until May 22, 2013. Information on diabetes complications was obtained from national health registers until December 31, 2012. Participation rates at the 2-, 10-, and 15-year examinations were 81%, 58%, and 41% in the control group and 90%, 76%, and 47% in the surgery group. For diabetes assessment, the median follow-up time was 10 years (interquartile range [IQR], 2-15) and 10 years (IQR, 10-15) in the control and surgery groups, respectively. For diabetes complications, the median follow-up time was 17.6 years (IQR, 14.2-19.8) and 18.1 years (IQR, 15.2-21.1) in the control and surgery groups, respectively.Adjustable or nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) procedures were performed in the surgery group, and usual obesity and diabetes care was provided to the control group.Diabetes remission, relapse, and diabetes complications. Remission was defined as blood glucose <110 mg/dL and no diabetes medication.The diabetes remission rate 2 years after surgery was 16.4% (95% CI, 11.7%-22.2%; 34/207) for control patients and 72.3% (95% CI, 66.9%-77.2%; 219/303) for bariatric surgery patients (odds ratio [OR], 13.3; 95% CI, 8.5-20.7; P < .001). At 15 years, the diabetes remission rates decreased to 6.5% (4/62) for control patients and to 30.4% (35/115) for bariatric surgery patients (OR, 6.3; 95% CI, 2.1-18.9; P < .001). With long-term follow-up, the cumulative incidence of microvascular complications was 41.8 per 1000 person-years (95% CI, 35.3-49.5) for control patients and 20.6 per 1000 person-years (95% CI, 17.0-24.9) in the surgery group (hazard ratio [HR], 0.44; 95% CI, 0.34-0.56; P < .001). Macrovascular complications were observed in 44.2 per 1000 person-years (95% CI, 37.5-52.1) in control patients and 31.7 per 1000 person-years (95% CI, 27.0-37.2) for the surgical group (HR, 0.68; 95% CI, 0.54-0.85; P = .001).In this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care. These findings require confirmation in randomized trials. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01479452.

Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

2000-10-01
Philip R. Schauer , Sayeed Ikramuddin , William Gourash +2 more
To evaluate the short-term outcomes for laparoscopic Roux-en-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months.The Roux-en-Y gastric bypass is a highly successful approach to 
 To evaluate the short-term outcomes for laparoscopic Roux-en-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months.The Roux-en-Y gastric bypass is a highly successful approach to morbid obesity but results in significant perioperative complications. A laparoscopic approach has significant potential to reduce perioperative complications and recovery time.Consecutive patients (n = 275) who met NIH criteria for bariatric surgery were offered laparoscopic Roux-en-Y gastric bypass between July 1997 and March 2000. A 15-mL gastric pouch and a 75-cm Roux limb (150 cm for superobese) was created using five or six trocar incisions.The conversion rate to open gastric bypass was 1%. The start of an oral diet began a mean of 1.58 days after surgery, with a median hospital stay of 2 days and return to work at 21 days. The incidence of early major and minor complications was 3.3% and 27%, respectively. One death occurred related to a pulmonary embolus (0.4%). The hernia rate was 0.7%, and wound infections requiring outpatient drainage only were uncommon (5%). Excess weight loss at 24 and 30 months was 83% and 77%, respectively. In patients with more than 1 year of follow-up, most of the comorbidities were improved or resolved, and 95% reported significant improvement in quality of life.Laparoscopic Roux-en-Y gastric bypass is effective in achieving weight loss and in improving comorbidities and quality of life while reducing recovery time and perioperative complications.

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

2007-03-13
Jan Karlsson , Charles Taft , Anna Rydén +2 more

The Effectiveness and Risks of Bariatric Surgery

2013-12-19
Su‐Hsin Chang , C Stoll , Ji‐Hyun Song +3 more
IMPORTANCEThe prevalence of obesity and outcomes of bariatric surgery are well established.However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.OBJECTIVE To examine the effectiveness 
 IMPORTANCEThe prevalence of obesity and outcomes of bariatric surgery are well established.However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.OBJECTIVE To examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques.DATA SOURCES Literature searches of Medline, Embase, Scopus, Current Contents, Cochrane Library, and Clinicaltrials.govbetween 2003 and 2012 were performed.STUDY SELECTION Exclusion criteria included publication of abstracts only, case reports, letters, comments, or reviews; animal studies; languages other than English; duplicate studies; no surgical intervention; and no population of interest.Inclusion criteria were a report of surgical procedure performed and at least 1 outcome of interest resulting from the studied surgery was reported: comorbidities, mortality, complications, reoperations, or weight loss.Of the 25 060 initially identified articles, 24 023 studies met the exclusion criteria, and 259 met the inclusion criteria.DATA EXTRACTION AND SYNTHESIS A review protocol was followed throughout.Three reviewers independently reviewed studies, abstracted data, and resolved disagreements by consensus.Studies were evaluated for quality.MAIN OUTCOMES AND MEASURES Mortality, complications, reoperations, weight loss, and remission of obesity-related diseases.RESULTS A total of 164 studies were included (37 randomized clinical trials and 127 observational studies).Analyses included 161 756 patients with a mean age of 44.56 years and body mass index of 45.62.We conducted random-effects and fixed-effect meta-analyses and meta-regression.In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%);the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%).Body mass index loss at 5 years postsurgery was 12 to 17.The complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%).Gastric bypass was more effective in weight loss but associated with more complications.Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass.Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.CONCLUSIONS AND RELEVANCE Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist.Death rates were lower than those reported in previous meta-analyses.
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The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis

2009-03-25
Daphne Guh , Wei Zhang , Nick Bansback +3 more
Abstract Background Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is 
 Abstract Background Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is to provide an estimate of the incidence of each co-morbidity related to obesity and overweight using a meta-analysis. Methods A literature search for the twenty co-morbidities identified in a preliminary search was conducted in Medline and Embase (Jan 2007). Studies meeting the inclusion criteria (prospective cohort studies of sufficient size reporting risk estimate based on the incidence of disease) were extracted. Study-specific unadjusted relative risks (RRs) on the log scale comparing overweight with normal and obese with normal were weighted by the inverse of their corresponding variances to obtain a pooled RR with 95% confidence intervals (CI). Results A total of 89 relevant studies were identified. The review found evidence for 18 co-morbidities which met the inclusion criteria. The meta-analysis determined statistically significant associations for overweight with the incidence of type II diabetes, all cancers except esophageal (female), pancreatic and prostate cancer, all cardiovascular diseases (except congestive heart failure), asthma, gallbladder disease, osteoarthritis and chronic back pain. We noted the strongest association between overweight defined by body mass index (BMI) and the incidence of type II diabetes in females (RR = 3.92 (95% CI: 3.10–4.97)). Statistically significant associations with obesity were found with the incidence of type II diabetes, all cancers except esophageal and prostate cancer, all cardiovascular diseases, asthma, gallbladder disease, osteoarthritis and chronic back pain. Obesity defined by BMI was also most strongly associated with the incidence of type II diabetes in females (12.41 (9.03–17.06)). Conclusion Both overweight and obesity are associated with the incidence of multiple co-morbidities including type II diabetes, cancer and cardiovascular diseases. Maintenance of a healthy weight could be important in the prevention of the large disease burden in the future. Further studies are needed to explore the biological mechanisms that link overweight and obesity with these co-morbidities.
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Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes

2008-01-22
John B. Dixon , Paul E. O’Brien , Julie Playfair +6 more
Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.To determine if surgically induced weight loss results in better glycemic control and less 
 Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.actr.org Identifier: ACTRN012605000159651.

Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

2008-03-01
Stavros Karamanakos , Konstantinos Vagenas , Fotis Kalfarentzos +1 more
In Brief Background: Bariatric surgery is currently the most effective treatment in morbidly obese patients, leading to durable weight loss. Objective: In this prospective double blind study, we aim to 
 In Brief Background: Bariatric surgery is currently the most effective treatment in morbidly obese patients, leading to durable weight loss. Objective: In this prospective double blind study, we aim to evaluate and compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with laparoscopic sleeve gastrectomy (LSG) on body weight, appetite, fasting, and postprandial ghrelin and peptide-YY (PYY) levels. Methods: After randomization, 16 patients were assigned to LRYGBP and 16 patients to LSG. Patients were reevaluated on the 1st, 3rd, 6th, and 12th postoperative month. Blood samples were collected after an overnight fast and in 6 patients in each group after a standard 420 kcal mixed meal. Results: Body weight and body mass index (BMI) decreased markedly (P < 0.0001) and comparably after either procedure. Excess weight loss was greater after LSG at 6 months (55.5% ± 7.6% vs. 50.2% ± 6.5%, P = 0.04) and 12 months (69.7% ± 14.6% vs. 60.5% ± 10.7%, [P = 0.05]). After LRYGBP fasting ghrelin levels did not change significantly compared with baseline (P = 0.19) and did not decrease significantly after the test meal. On the other hand, LSG was followed by a marked reduction in fasting ghrelin levels (P < 0.0001) and a significant suppression after the meal. Fasting PYY levels increased after either surgical procedure (P ≀ 0.001). Appetite decreased in both groups but to a greater extend after LSG. Conclusion: PYY levels increased similarly after either procedure. The markedly reduced ghrelin levels in addition to increased PYY levels after LSG, are associated with greater appetite suppression and excess weight loss compared with LRYGBP. In this prospective double blind study, we evaluate and compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with laparoscopic sleeve gastrectomy (LSG), on body weight, appetite and also fasting and postprandial ghrelin and peptide-YY (PYY) levels. After randomization, 16 patients were assigned in each group. LSG leads to greater excess weight loss and appetite suppression compared with LRYGBP. PYY levels increased similarly after either procedure, but ghrelin levels decreased markedly only after LSG, and this may explain its greater effect on excess weight loss and appetite suppression.

Gut Hormone Profiles Following Bariatric Surgery Favor an Anorectic State, Facilitate Weight Loss, and Improve Metabolic Parameters

2005-12-21
Carel W. le Roux , Simon Aylwin , Rachel L. Batterham +7 more
To study the effect of bariatric surgery on the entero-hypothalamic endocrine axis of humans and rodents.Bariatric surgery is the most effective obesity treatment as it achieves substantial and sustained weight 
 To study the effect of bariatric surgery on the entero-hypothalamic endocrine axis of humans and rodents.Bariatric surgery is the most effective obesity treatment as it achieves substantial and sustained weight loss. Glycemic control and enhanced satiation improve before substantial weight loss occurs. Gut peptides, acting both peripherally and centrally, contribute to glycemic control and regulate food intake.We examined meal-stimulated responses of insulin, ghrelin, peptide YY (PYY), glucagon-like-peptide-1 (GLP-1), and pancreatic polypeptide (PP) in humans and rodents following different bariatric surgical techniques.Compared with lean and obese controls, patients following Roux-en-Y gastric bypass (RYGB) had increased postprandial plasma PYY and GLP-1 favoring enhanced satiety. Furthermore, RYGB patients had early and exaggerated insulin responses, potentially mediating improved glycemic control. None of these effects were observed in patients losing equivalent weight through gastric banding. Leptin, ghrelin, and PP were similar in both the surgical groups. Using a rodent model of jejuno-intestinal bypass (JIB), we showed elevated PYY and GLP-1 in JIB rats compared with sham-operated rats. Moreover, exogenous PYY reduced food intake and blockade of endogenous PYY increased food intake. Thus, higher plasma PYY following JIB may contribute to reduced food intake and contribute to weight loss.Following RYGB and JIB, a pleiotropic endocrine response may contribute to the improved glycemic control, appetite reduction, and long-term changes in body weight.

Laparoscopic Gastric Bypass, Roux en-Y - 500 Patients: Technique and Results, with 3-60 month follow-up

2000-06-01
Alan C. Wittgrove , G. Wesley Clark

Biliopancreatic Diversion with a Duodenal Switch

1998-06-01
Douglas S. Hess , Douglas William Hess

Long-term Results of Laparoscopic Sleeve Gastrectomy for Obesity

2010-07-09
Jacqués Himpens , Julie M.L.C.L. Dobbeleir , Geert Peeters
In Brief Objective: To determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy as treatment for morbid obesity. Summary Background Data: Laparoscopic sleeve gastrectomy is 
 In Brief Objective: To determine the mid- and long-term efficacy and possible side effects of laparoscopic sleeve gastrectomy as treatment for morbid obesity. Summary Background Data: Laparoscopic sleeve gastrectomy is still controversial as single and final treatment for morbid obesity. Some favorable short-term results have been published, however long-term results are still lacking. Methods: In the period between November 2001 and October 2002, 53 consecutive morbidly obese patients who, according to our personal algorithm, were qualified for restrictive surgery were selected for laparoscopic sleeve gastrectomy. Of the 53 patients, 11 received an additional malabsorptive procedure at a later stage because of weight regain. The percentage of excess weight loss (EWL) was assessed at 3 and 6 years postoperatively. A retrospective review of a prospectively collected database was performed for evaluation after 3 years. Recently, after the sixth postoperative year, patients were again contacted and invited to fill out a questionnaire. Results: Full cooperation was obtained in 41 patients, a response rate of 78%. Although after 3 years a mean EWL of 72.8% was documented, after 6 years EWL had dropped to 57.3%, which according to the Reinhold criteria is still satisfactory. These results included 11 patients who had benefited from an additional malabsorptive procedure (duodenal switch) and 2 patients who underwent a "resleeve" between the third and sixth postoperative year. Analyzing the results of the subgroup of 30 patients receiving only sleeve gastrectomy, we found a 3-year %EWL of 77.5% and 6+ year %EWL of 53.3%. The differences between the third and sixth postoperative year were statistically significant in both groups. Concerning long-term quality of life patient acceptance stayed good after 6 + years despite the fact that late, new gastro-esophageal reflux complaints appeared in 21% of patients. Conclusions: In this long-term report of laparoscopic sleeve gastrectomy, it appears that after 6+ years the mean excess weight loss exceeds 50%. However, weight regain and de novo gastroesophageal reflux symptoms appear between the third and the sixth postoperative year. This unfavorable evolution might have been prevented in some patients by continued follow-up office visits beyond the third year. Patient acceptance remains good after 6+ years. In this long-term follow-up study of laparoscopic sleeve gastrectomy for morbid obesity, it appears that patients experience weight regain between the third and the sixth postoperative year. Remaining weight loss after 6+ years is still acceptable. Gastroesophageal reflux symptoms are a frequent complaint. Patient acceptance is good.

Review of the key results from the Swedish Obese Subjects (<scp>SOS</scp>) trial – a prospective controlled intervention study of bariatric surgery

2013-02-08
L. Sjöström
Abstract Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. 
 Abstract Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects ( SOS ) study is the first long‐term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints. The SOS study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The age of participants was 37–60 years and body mass index ( BMI ) was ≄34 kg m −2 in men and ≄38 kg m −2 in women. Here, we review the key SOS study results published between 2004 and 2012. Follow‐up periods varied from 10 to 20 years in different reports. The mean changes in body weight after 2, 10, 15 and 20 years were −23%, −17%, −16% and −18% in the surgery group and 0%, 1%, −1% and −1% in the control group respectively. Compared with usual care, bariatric surgery was associated with a long‐term reduction in overall mortality (primary endpoint) [adjusted hazard ratio ( HR ) = 0.71, 95% confidence interval ( CI ) 0.54–0.92; P = 0.01] and decreased incidences of diabetes (adjusted HR =0.17; P &lt; 0.001), myocardial infarction (adjusted HR = 0.71; P = 0.02), stroke (adjusted HR =0.66; P = 0.008) and cancer (women: adjusted HR = 0.58; P = 0.0008; men: n.s.]. The diabetes remission rate was increased severalfold at 2 years [adjusted odds ratio ( OR ) = 8.42; P &lt; 0.001] and 10 years (adjusted OR = 3.45; P &lt; 0.001). Whereas high insulin and/or high glucose at baseline predicted favourable treatment effects, high baseline BMI did not, indicating that current selection criteria for bariatric surgery need to be revised.
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Laparoscopic Gastric Bypass, Roux-en-Y: Preliminary Report of Five Cases

1994-11-01
Alan C. Wittgrove , G. Wesley Clark , Laurier Tremblay

Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus

1995-09-01
Walter J. Pories , Melvin Swanson , Kenneth G. MacDonald +7 more
Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes. Summary Background Data Obesity and diabetes, both notoriously resistant to medical therapy, continue to 
 Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes. Summary Background Data Obesity and diabetes, both notoriously resistant to medical therapy, continue to be two of our most common and serious diseases. Methods Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mL, (2) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of the patients were seriously ill, the operation was performed with a perioperative mortality and complication rate of 1.5% and 8.5%, respectively. Seventeen of the 608 patients (<3%) were lost to follow-up. Results Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (range, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 to 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years. The operation provides long-term control of non-insulin-dependent diabetes mellitus (NIDDM). In those patients with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in caloric intake, suggesting that insulin resistance is a secondary protective effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a number of other comorbidities of obesity, including hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility.
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Long-Term Mortality after Gastric Bypass Surgery

2007-08-22
Ted D. Adams , Richard E. Gress , Sherman C. Smith +6 more
Although gastric bypass surgery accounts for 80% of bariatric surgery in the United States, only limited long-term data are available on mortality among patients who have undergone this procedure as 
 Although gastric bypass surgery accounts for 80% of bariatric surgery in the United States, only limited long-term data are available on mortality among patients who have undergone this procedure as compared with severely obese persons from a general population.
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Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus

2003-10-01
Philip R. Schauer , Bartolomé Burguera , Sayeed Ikramuddin +7 more
In Brief Objective: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 
 In Brief Objective: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). Summary Background Data: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes. Methods: We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. Results: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26–67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. Conclusion: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic. In patients with type 2 diabetes (T2DM), laparoscopic Roux-en-Y gastric bypass resulted in 60% percent of excess body weight loss and 83% resolution of diabetes. Patients with T2DM < 5 years and mild disease had a much higher rate of resolution after surgery (95% and 97%, respectively) than patients with T2DM >10 years or severe disease (54% and 62%, respectively).

Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients

2004-08-19
Nicolas V. Christou , John S. Sampalis , MoĂŻshe Liberman +4 more
This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients.Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term 
 This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients.Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown.We used an observational 2-cohort study. The treatment cohort (n = 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n = 5746) included age- and gender-matched severely obese patients who had not undergone weight-reduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception.The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P < 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%.This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.

Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs

2001-09-01
Ninh T. Nguyen , Charles D. Goldman , C. J. Rosenquist +4 more
Objective To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data Laparoscopic GBP has been reported to be a safe and 
 Objective To compare outcomes, quality of life (QOL), and costs of laparoscopic and open gastric bypass (GBP). Summary Background Data Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity. The authors performed a prospective randomized trial to compare outcomes, QOL, and costs of laparoscopic GBP with those of open GBP. Methods From May 1999 to March 2001, 155 patients with a body mass index (BMI) of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 79) or open (n = 76) GBP. The two groups were similar in age, sex ratio, mean BMI, and comorbidities. Main outcome measures included operative time, estimated blood loss, length of hospital stay, operative complications, percentage of excess body weight loss, and time to return to activities of daily living and work. Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system (BAROS). Operative and hospital costs of the two operations were also compared. Results There were no deaths in either group. Mean operative time was longer for laparoscopic GBP than for open GBP, but operative blood loss was less. Two (2.5%) of the 79 patients in the laparoscopic group required conversion to laparotomy. Median length of hospital stay was shorter for laparoscopic GBP patients (3 vs 4 days). The rate of postoperative anastomotic leak was similar between groups. Wound-related complications such as infection (10.5 vs 1.3%) and incisional hernia (7.9 vs 0%) were more common after open GBP; late anastomotic stricture was less frequent after open GBP (2.6 vs 11.4%). Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP. Weight loss at 1 year was similar between groups. Preoperative SF-36 scores were similar between groups; however, at 1 month after surgery, laparoscopic patients had better physical conditioning, social functioning, general health, and less body pain than open GBP patients. At 6 months, the BAROS outcome was classified as good or better in 97% of laparoscopic GBP patients compared with 82% of open GBP patients. Operative costs were higher for laparoscopic GBP patients, but hospital costs were lower. Conclusions Laparoscopic GBP is a safe and cost-effective alternative to open GBP. Despite a longer operative time, patients undergoing laparoscopic GBP benefited from less blood loss, a shorter hospital stay, and faster convalescence. Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients. The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs.

The Mechanism of Diabetes Control After Gastrointestinal Bypass Surgery Reveals a Role of the Proximal Small Intestine in the Pathophysiology of Type 2 Diabetes

2006-10-20
Francesco Rubino , Antonello Forgione , David E. Cummings +5 more
Most patients who undergo Roux-en-Y gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior studies indicate that this results from more than gastric restriction and weight loss, implicating 
 Most patients who undergo Roux-en-Y gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior studies indicate that this results from more than gastric restriction and weight loss, implicating the rearranged intestine as a primary mediator. It is unclear, however, if diabetes improves because of enhanced delivery of nutrients to the distal intestine and increased secretion of hindgut signals that improve glucose homeostasis, or because of altered signals from the excluded segment of proximal intestine. We sought to distinguish between these two mechanisms.Goto-Kakizaki (GK) type 2 diabetic rats underwent duodenal-jejunal bypass (DJB), a stomach-preserving RYGB that excludes the proximal intestine, or a gastrojejunostomy (GJ), which creates a shortcut for ingested nutrients without bypassing any intestine. Controls were pair-fed (PF) sham-operated and untreated GK rats. Rats that had undergone GJ were then reoperated to exclude the proximal intestine; and conversely, duodenal passage was restored in rats that had undergone DJB. Oral glucose tolerance (OGTT), food intake, body weight, and intestinal nutrient absorption were measured.There were no differences in food intake, body weight, or nutrient absorption among surgical groups. DJB-treated rats had markedly better oral glucose tolerance compared with all control groups as shown by lower peak and area-under-the-curve glucose values (P < 0.001 for both). GJ did not affect glucose homeostasis, but exclusion of duodenal nutrient passage in reoperated GJ rats significantly improved glucose tolerance. Conversely, restoration of duodenal passage in DJB rats reestablished impaired glucose tolerance.This study shows that bypassing a short segment of proximal intestine directly ameliorates type 2 diabetes, independently of effects on food intake, body weight, malabsorption, or nutrient delivery to the hindgut. These findings suggest that a proximal intestinal bypass could be considered for diabetes treatment and that potentially undiscovered factors from the proximal bowel might contribute to the pathophysiology of type 2 diabetes.

International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of &gt;12,000 cases

2011-11-11
RaĂșl J. Rosenthal

Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis

2009-03-01
Hēnry Buchwald , Rhonda Estok , Kyle Fahrbach +5 more

Bariatric Surgery

2004-10-12
Hēnry Buchwald , Yoav Avidor , Eugene Braunwald +4 more
About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.To determine the impact of 
 About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials

2013-10-22
Viktoria Gloy , Matthias Briel , Deepak L. Bhatt +5 more
<b>Objective</b> To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. <b>Design</b> Systematic review and meta-analysis based on a random effects model. <b>Data sources</b> Searches of 
 <b>Objective</b> To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. <b>Design</b> Systematic review and meta-analysis based on a random effects model. <b>Data sources</b> Searches of Medline, Embase, and the <i>Cochrane Library</i> from their inception to December 2012 regardless of language or publication status. <b>Eligibility criteria </b>Eligible studies were randomised controlled trials with ≄6 months of follow-up that included individuals with a body mass index ≄30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. <b>Results</b> The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference −26 kg (95% confidence interval −31 to −21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference −0.7 mmol/L (−1.0 to −0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). <b>Conclusions</b> Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals. <b>Systematic review registration</b> PROSPERO CRD42012003317 (www.crd.york.ac.uk/PROSPERO).
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Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects

2007-08-22
Lars Sjöström , Kristina Narbro , C. David Sjöström +7 more
Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies 
 Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality.The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%).The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29).Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
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Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes

2012-03-26
Philip R. Schauer , Sangeeta R. Kashyap , Kathy Wolski +7 more
Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery.In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus 
 Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery.In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The mean (±SD) age of the patients was 49±8 years, and 66% were women. The average glycated hemoglobin level was 9.2±1.5%. The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0% or less 12 months after treatment.Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medical-therapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P=0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P=0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% in the sleeve-gastrectomy group (P=0.003). Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group (-29.4±9.0 kg and -25.1±8.5 kg, respectively) than in the medical-therapy group (-5.4±8.0 kg) (P<0.001 for both comparisons). The use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only. The index for homeostasis model assessment of insulin resistance (HOMA-IR) improved significantly after bariatric surgery. Four patients underwent reoperation. There were no deaths or life-threatening complications.In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results. (Funded by Ethicon Endo-Surgery and others; ClinicalTrials.gov number, NCT00432809.).
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Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic &amp; bariatric surgery*

2013-03-01
Jeffrey I. Mechanick , Adrienne Youdim , Daniel B. Jones +7 more
Abstract Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of 
 Abstract Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re‐evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type‐2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE‐TOS‐ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
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Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery

2004-12-22
Lars Sjöström , Anna‐Karin Lindroos , Markku Peltonen +7 more
Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown. Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.
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Trends in Bariatric Surgical Procedures

2005-10-18
Heena P. Santry
ContextThe increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions 
 ContextThe increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity.ObjectiveTo examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States.Design, Setting, and PatientsThe Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates.Main Outcome MeasuresTrends in bariatric surgical procedures, patient characteristics, and complications.ResultsThe estimated number of bariatric surgical procedures increased from 13 365 in 1998 to 72 177 in 2002 (P&lt;.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P&lt;.001), and patients aged 50 to 64 years (15% to 24%; P&lt;.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P&lt;.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low.ConclusionsThese findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.

Bariatric Surgery and Long-term Cardiovascular Events

2012-01-03
Lars Sjöström , Markku Peltonen , Peter Jacobson +7 more
Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.To study the association between bariatric surgery, weight loss, and cardiovascular 
 Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.To study the association between bariatric surgery, weight loss, and cardiovascular events.The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals.The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined.Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001).Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

Meta-Analysis: Surgical Treatment of Obesity

2005-04-05
Melinda A. Maggard , Lisa R. Shugarman , Marika J Suttorp +7 more
Background: Controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in health-related outcomes. Purpose: To perform a meta-analysis of effectiveness and adverse events associated with 
 Background: Controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in health-related outcomes. Purpose: To perform a meta-analysis of effectiveness and adverse events associated with surgical treatment of obesity. Data Sources: MEDLINE, EMBASE, Cochrane Controlled Trials Register, and systematic reviews. Study Selection: Randomized, controlled trials; observational studies; and case series reporting on surgical treatment of obesity. Data Extraction: Information about study design, procedure, population, comorbid conditions, and adverse events. Data Synthesis: The authors assessed 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. The authors identified 1 large, matched cohort analysis that reported greater weight loss with surgery than with medical treatment in individuals with an average body mass index (BMI) of 40 kg/m2 or greater. Surgery resulted in a weight loss of 20 to 30 kg, which was maintained for up to 10 years and was accompanied by improvements in some comorbid conditions. For BMIs of 35 to 39 kg/m2, data from case series strongly support superiority of surgery but cannot be considered conclusive. Gastric bypass procedures result in more weight loss than gastroplasty. Bariatric procedures in current use (gastric bypass, laparoscopic adjustable gastric band, vertical banded gastroplasty, and biliopancreatic diversion and switch) have been performed with an overall mortality rate of less than 1%. Adverse events occur in about 20% of cases. A laparoscopic approach results in fewer wound complications than an open approach. Limitations: Only a few controlled trials were available for analysis. Heterogeneity was seen among studies, and publication bias is possible. Conclusions: Surgery is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 kg/m2 or greater. More data are needed to determine the efficacy of surgery relative to nonsurgical therapy for less severely obese people. Procedures differ in efficacy and incidence of complications.

Bariatric Surgery Worldwide 2013

2015-04-03
Luigi Angrisani , Antonella Santonicola , Paola Iovino +3 more

Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes

2012-03-26
Geltrude Mingrone , Simona Panunzi , Andrea De Gaetano +7 more
Roux-en-Y gastric bypass and biliopancreatic diversion can markedly ameliorate diabetes in morbidly obese patients, often resulting in disease remission. Prospective, randomized trials comparing these procedures with medical therapy for the 
 Roux-en-Y gastric bypass and biliopancreatic diversion can markedly ameliorate diabetes in morbidly obese patients, often resulting in disease remission. Prospective, randomized trials comparing these procedures with medical therapy for the treatment of diabetes are needed.In this single-center, nonblinded, randomized, controlled trial, 60 patients between the ages of 30 and 60 years with a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or more, a history of at least 5 years of diabetes, and a glycated hemoglobin level of 7.0% or more were randomly assigned to receive conventional medical therapy or undergo either gastric bypass or biliopancreatic diversion. The primary end point was the rate of diabetes remission at 2 years (defined as a fasting glucose level of <100 mg per deciliter [5.6 mmol per liter] and a glycated hemoglobin level of <6.5% in the absence of pharmacologic therapy).At 2 years, diabetes remission had occurred in no patients in the medical-therapy group versus 75% in the gastric-bypass group and 95% in the biliopancreatic-diversion group (P<0.001 for both comparisons). Age, sex, baseline BMI, duration of diabetes, and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months. At 2 years, the average baseline glycated hemoglobin level (8.65±1.45%) had decreased in all groups, but patients in the two surgical groups had the greatest degree of improvement (average glycated hemoglobin levels, 7.69±0.57% in the medical-therapy group, 6.35±1.42% in the gastric-bypass group, and 4.95±0.49% in the biliopancreatic-diversion group).In severely obese patients with type 2 diabetes, bariatric surgery resulted in better glucose control than did medical therapy. Preoperative BMI and weight loss did not predict the improvement in hyperglycemia after these procedures. (Funded by Catholic University of Rome; ClinicalTrials.gov number, NCT00888836.).
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Surgery for weight loss in adults

2014-08-08
Jill L Colquitt , Karen Pickett , Emma Loveman +1 more

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes

2014-03-31
Philip R. Schauer , Deepak L. Bhatt , John P. Kirwan +7 more
In short-term randomized trials (duration, 1 to 2 years), bariatric surgery has been associated with improvement in type 2 diabetes mellitus.We assessed outcomes 3 years after the randomization of 150 
 In short-term randomized trials (duration, 1 to 2 years), bariatric surgery has been associated with improvement in type 2 diabetes mellitus.We assessed outcomes 3 years after the randomization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point was a glycated hemoglobin level of 6.0% or less.The mean (±SD) age of the patients at baseline was 48±8 years, 68% were women, the mean baseline glycated hemoglobin level was 9.3±1.5%, and the mean baseline body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.0±3.5. A total of 91% of the patients completed 36 months of follow-up. At 3 years, the criterion for the primary end point was met by 5% of the patients in the medical-therapy group, as compared with 38% of those in the gastric-bypass group (P<0.001) and 24% of those in the sleeve-gastrectomy group (P=0.01). The use of glucose-lowering medications, including insulin, was lower in the surgical groups than in the medical-therapy group. Patients in the surgical groups had greater mean percentage reductions in weight from baseline, with reductions of 24.5±9.1% in the gastric-bypass group and 21.1±8.9% in the sleeve-gastrectomy group, as compared with a reduction of 4.2±8.3% in the medical-therapy group (P<0.001 for both comparisons). Quality-of-life measures were significantly better in the two surgical groups than in the medical-therapy group. There were no major late surgical complications.Among obese patients with uncontrolled type 2 diabetes, 3 years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone. Analyses of secondary end points, including body weight, use of glucose-lowering medications, and quality of life, also showed favorable results at 3 years in the surgical groups, as compared with the group receiving medical therapy alone. (Funded by Ethicon and others; STAMPEDE ClinicalTrials.gov number, NCT00432809.).
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Metabolic/Bariatric Surgery Worldwide 2011

2013-01-21
Hēnry Buchwald , Danette M. Oien

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

2009-09-01
Joanna Picot , Jeremy Jones , Jill L Colquitt +4 more
Objectives To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Data sources Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane 
 Objectives To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Data sources Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references Review methods Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) ≄ 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI ≄ 40; BMI ≄ 30 and < 40 with Type 2 diabetes at baseline; and BMI ≄ 30 and < 35. Models were applied with assumptions on costs and comorbidity. Results A total of 5386 references were identified of which 26 were included in the clinical effectiveness review: three randomised controlled trials (RCTs) and three cohort studies compared surgery with non-surgical interventions and 20 RCTs compared different surgical procedures. Bariatric surgery was a more effective intervention for weight loss than non-surgical options. In one large cohort study weight loss was still apparent 10 years after surgery, whereas patients receiving conventional treatment had gained weight. Some measures of QoL improved after surgery, but not others. After surgery statistically fewer people had metabolic syndrome and there was higher remission of Type 2 diabetes than in non-surgical groups. In one large cohort study the incidence of three out of six comorbidities assessed 10 years after surgery was significantly reduced compared with conventional therapy. Gastric bypass (GBP) was more effective for weight loss than vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). Laparoscopic isolated sleeve gastrectomy (LISG) was more effective than AGB in one study. GBP and banded GBP led to similar weight loss and results for GBP versus LISG and VBG versus AGB were equivocal. All comparisons of open versus laparoscopic surgeries found similar weight losses in each group. Comorbidities after surgery improved in all groups, but with no significant differences between different surgical interventions. Adverse event reporting varied; mortality ranged from none to 10%. Adverse events from conventional therapy included intolerance to medication, acute cholecystitis and gastrointestinal problems. Major adverse events following surgery, some necessitating reoperation, included anastomosis leakage, pneumonia, pulmonary embolism, band slippage and band erosion. Bariatric surgery was cost-effective in comparison to non-surgical treatment in the reviewed published estimates of cost-effectiveness. However, these estimates are likely to be unreliable and not generalisable because of methodological shortcomings and the modelling assumptions made. Therefore a new economic model was developed. Surgical management was more costly than non-surgical management in each of the three patient populations analysed, but gave improved outcomes. For morbid obesity, incremental cost-effectiveness ratios (ICERs) (base case) ranged between ÂŁ2000 and ÂŁ4000 per QALY gained. They remained within the range regarded as cost-effective from an NHS decision-making perspective when assumptions for deterministic sensitivity analysis were changed. For BMI ≄ 30 and < 40, ICERs were ÂŁ18,930 at two years and ÂŁ1397 at 20 years, and for BMI ≄ 30 and < 35, ICERs were ÂŁ60,754 at two years and ÂŁ12,763 at 20 years. Deterministic and probabilistic sensitivity analyses produced ICERs which were generally within the range considered cost-effective, particularly at the long twenty year time horizons, although for the BMI 30-35 group some ICERs were above the acceptable range. Conclusions Bariatric surgery appears to be a clinically effective and cost-effective intervention for moderately to severely obese people compared with non-surgical interventions. Uncertainties remain and further research is required to provide detailed data on patient QoL; impact of surgeon experience on outcome; late complications leading to reoperation; duration of comorbidity remission; resource use. Good-quality RCTs will provide evidence on bariatric surgery for young people and for adults with class I or class II obesity. New research must report on the resolution and/or development of comorbidities such as Type 2 diabetes and hypertension so that the potential benefits of early intervention can be assessed.
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Effect of Partial Ileal Bypass Surgery on Mortality and Morbidity from Coronary Heart Disease in Patients with Hypercholesterolemia

1990-10-04
Hēnry Buchwald , Richard L. Varco , John P. Matts +7 more
The Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized clinical trial, was designed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably 
 The Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized clinical trial, was designed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality or mortality due to coronary heart disease. The study population consisted of 838 patients (417 in the control group and 421 in the surgery group), both men (90.7 percent) and women, with an average age of 51 years, who had survived a first myocardial infarction. The mean follow-up period was 9.7 years.
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Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

2016-05-13
Francesco Rubino , David M. Nathan , Robert H. Eckel +7 more
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an 
 BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005–30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28–30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≄40 kg/m2) and in those with class II obesity (BMI 35.0–39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0–34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.

Gastrointestinal Surgery for Severe Obesity

1991-12-15
Surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals, as well as members of the public convened to address nonsurgical treatments for severe obesity, surgical treatments for severe obesity, 
 Surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals, as well as members of the public convened to address nonsurgical treatments for severe obesity, surgical treatments for severe obesity, and criteria for selection, the efficacy, and risks of surgical treatments for severe obesity, and the need for future research on and epidemiologic evaluation of these therapies. The National Institutes of Health Consensus Development Panel recommended that patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program that integrates a dietary regimen, appropriate exercise, behavior modification, and psychological support; that gastric restrictive or bypass procedures could be considered for well-informed and motivated patients in whom the operative risks were acceptable; that patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise; that surgery be done by a surgeon who has substantial experience in the particular procedure and who works in a clinical setting with adequate support for all aspects of management and assessment; and that patients undergo lifelong medical surveillance after surgery.

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

2017-12-05
Michael EJ Lean , W. S. Leslie , Alison C. Barnes +7 more
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Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity

2018-01-16
Ralph Peterli , Bettina K. Wölnerhanssen , Thomas Peters +7 more
<h3>Importance</h3> Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. <h3>Objective</h3> To determine whether there 
 <h3>Importance</h3> Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. <h3>Objective</h3> To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. <h3>Design, Setting, and Participants</h3> The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period. <h3>Interventions</h3> Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110). <h3>Main Outcomes and Measures</h3> The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. <h3>Results</h3> Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, −7.18%; 95% CI, −14.30% to −0.06%;<i>P</i> = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass. <h3>Conclusions and Relevance</h3> Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT00356213
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Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity

2018-01-16
Paulina Salminen , Mika Helmiö , Jari Ovaska +7 more
Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass.

IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures

2018-08-18
Luigi Angrisani , Antonella Santonicola , Paola Iovino +5 more

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

2017-02-15
Philip R. Schauer , Deepak L. Bhatt , John P. Kirwan +7 more
Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited.We assessed outcomes 5 years after 150 patients who had 
 Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited.We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications.Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P=0.01, adjusted P=0.03, P=0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P=0.03, adjusted P=0.07, P=0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P=0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (-23%, -19%, and -5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (-40%, -29%, and -8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (-35%, -34%, and -13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation.Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia. (Funded by Ethicon Endo-Surgery and others; STAMPEDE ClinicalTrials.gov number, NCT00432809 .).
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Metabolic/Bariatric Surgery Worldwide 2008

2009-11-02
Hēnry Buchwald , Danette M. Oien

Benefits and Risks of Bariatric Surgery in Adults

2020-09-01
David Arterburn , Dana A. Telem , Robert F. Kushner +1 more
<h3>Importance</h3> Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with 
 <h3>Importance</h3> Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations. <h3>Observations</h3> There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Although safety is a concern, current data indicate that the perioperative mortality rates range from 0.03% to 0.2%, which has substantially improved since early 2000s. More long-term randomized studies are needed to assess the effect of bariatric procedures on cardiovascular disease, cancer, and other health outcomes and to evaluate emerging newer procedures. <h3>Conclusions and Relevance</h3> Modern bariatric procedures have strong evidence of efficacy and safety. All patients with severe obesity—and especially those with type 2 diabetes—should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.

How Do I Manage Marginal Ulcers After Roux-En-Y Gastric Bypass?

2025-06-25
Zehra Naseem , Aun Muhammad , C. Roberto Simons-Linares | The American Journal of Gastroenterology

Effect of Opioid-Free Versus Opioid Anesthesia on the Quality of Postoperative Recovery in Patients Receiving Laparoscopic Sleeve Gastrectomy

2025-06-25
Bijia Song , Wenjing Li , Lei Wan +1 more | Obesity Surgery
Opioids are commonly used in general anesthesia for pain management. However, they are related to obvious side effects. Patients with obesity undergoing laparoscopic sleeve gastrectomy are at higher risk of 
 Opioids are commonly used in general anesthesia for pain management. However, they are related to obvious side effects. Patients with obesity undergoing laparoscopic sleeve gastrectomy are at higher risk of experiencing adverse effects associated with opioids. However, there is great heterogeneity in how to select and combine antinociceptive drugs to replace opioids. This randomized controlled double-blind study was conducted to evaluate the use effect of opioid-free anesthesia (OFA) in obese patients undergoing laparoscopic sleeve gastrectomy on the quality of postoperative recovery. This prospective, parallel-group, double-blind, randomized controlled study included seventy-six patients undergoing laparoscopic sleeve gastrectomy in Beijing Friendship Hospital, Capital Medical University. Patients were randomly assigned to OFA group or opioid-based anesthesia (OBA) group. The primary outcome included the 15-item recovery quality scale (QOR-15). Secondary measures included intraoperative hemodynamic stability, intraoperative operation information, duration of until postoperative PACU Aldrete score > 9 points, anesthesia-related complication, and number of analgesic pump presses. The scores of QOR-15 in OFA group were higher than that in OBA group at 24 h and 48 h after surgery. The total dose of propofol required in OFA group was statistically less than that in OBA group. Patients in the OBA group had significantly lower bispectral index (BIS) values and lower levels of MAP at T2 (after intubation) than those in the OFA group patients in the OBA group. Patients in the OFA group showed significantly lower levels of heart rate (HR) at T3 (after abdominal closure) when compared to the OBA group. The changing trend of visual analog scale (VAS) and OBAS scores recorded after surgery were similar between both groups and the VAS and Overall Benefit of Analgesia Scale (OBAS) scores in OBA group were obviously higher than those in OFA group in each time point. The Rhodes Index of Nausea and Vomiting in OBA group were obviously higher than those in OFA group in each time point. OFA significantly improved postoperative recovery quality as evidenced by higher QOR-15 scores, reduced postoperative nausea and vomiting (PONV), lower pain scores and decreased opioid requirements compared to OBA. Although duration of awakening from anesthesia was prolonged, OFA demonstrated superior recovery outcomes and fewer complications supporting its clinical utility in obese patients undergoing laparoscopic sleeve gastrectomy.

Management of Complex Silastic Ring Erosion Following Roux‐en‐Y Gastric Bypass

2025-06-24
Preekesh Suresh Patel , Michael Booth | ANZ Journal of Surgery

Bariatric Surgery vs. Low-energy Diet and Cardiometabolic Factors: a Systematic Review and Meta-analysis

2025-06-24
Saba Goodarzi , Akbar Shafiee , M. Rafiei +5 more | Obesity Surgery

Pregnancy Outcomes After One Anastomosis Gastric Bypass

2025-06-24
Amihai Rottenstreich , Ram Elazary , Tair Ben‐Porat +3 more | Obesity Surgery

Gastrointestinal Symptoms and Health-Related Quality of Life Following Metabolic Bariatric Surgery: A Prospective Cohort Study

2025-06-24
Lee S. Kyang , Ian N. Hines , Emma Thomas‐Jones +4 more | Obesity Surgery

Effectiveness of case management and psychological intervention nursing model in bariatric surgery patients

2025-06-24
Qin Sun , Aimei Jia , Yuan Zhang +3 more | Frontiers in Surgery
Objectives This study aimed to analyze the significance and value of the case management and psychological intervention model in bariatric surgery patients. Methods A retrospective study was conducted on 100 
 Objectives This study aimed to analyze the significance and value of the case management and psychological intervention model in bariatric surgery patients. Methods A retrospective study was conducted on 100 patients who underwent bariatric surgery admitted to the Affiliated Hospital of North Sichuan Medical College from January 1, 2021, to December 31, 2023. The patients were divided into two groups based on the nursing model. The control group ( n = 50) received conventional nursing, while the experimental group ( n = 50) was treated with case management combined with psychological intervention nursing. The changes in physical indicators, patient satisfaction, psychological condition, and quality of life were compared between the two groups. Results The body mass index (BMI) of the experimental group at 12 months post-surgery was significantly different from those of the control group ( P &amp;lt; 0.05). Regarding psychological assessment, the anxiety and depression scores of patients showed significant differences at the initial outpatient visit and discharge day ( P &amp;lt; 0.05). Quality of life indicators (physical function, bodily pain, emotional function, social function) were statistically significantly different at 6 months post-surgery ( P &amp;lt; 0.05). Conclusion The case management and psychological intervention model can significantly promote weight reduction, psychological assessments, and quality of life functions in patients after bariatric surgery.

Optimal Thromboprophylaxis in Laparoscopic Bariatric Surgery in a Private Third-Level Center in Mexico City

2025-06-23
David Lomeli-Reyes , Alejandro Martinez-Esteban , Natalia M Barron-Cervantes +3 more | Cureus

Late Complications of Bleeding in the First 24 H After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study

2025-06-23
Medeni Sermet , ÖzgĂŒr Ekinci , Orhan Alımoğlu | Obesity Surgery

Effect of bariatric surgery on glycemic and metabolic outcomes in people with obesity and type 2 diabetes mellitus: a systematic review, meta-analysis, and meta-evidence of 39 studies

2025-06-23
Wei Xiao , Haijuan Yuan , Daorong Wang +2 more | Frontiers in Nutrition
Background Bariatric surgery has become a widely utilized therapeutic approach for obesity management and glycemic regulation in individuals with type 2 diabetes mellitus (T2DM). This meta-analysis examines the effects of 
 Background Bariatric surgery has become a widely utilized therapeutic approach for obesity management and glycemic regulation in individuals with type 2 diabetes mellitus (T2DM). This meta-analysis examines the effects of bariatric surgery on key glycemic and metabolic parameters. Methods A systematic literature search was performed across PubMed, Scopus, Embase, and Web of Science to identify relevant studies assessing alterations in outcomes following bariatric surgery compared to baseline measurements. Eligible studies were analyzed using a random-effects model to compute weighted mean differences (WMD) and their corresponding 95% confidence intervals (CIs). Results Bariatric surgery resulted in 39 with 3,855 participants in significant reductions in fasting blood glucose (FBG) (WMD: −0.82 mg/dL; 95%CI: −0.92 to −0.72), postprandial glucose (PPG) (WMD: −4.15 mg/dL; 95%CI: −5.38 to −2.92), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) levels (WMD: -2.81; 95% CI: −3.06 to −2.56), C-peptide (WMD: -0.38; 95%CI: −0.73 to −0.03) and fasting insulin (WMD: -0.62; 95% CI: −0.88 to −0.36). No significant reduction in glycated hemoglobin (HbA1c) levels was observed (WMD: -0.17; 95%CI: −0.39 to 0.04). Follow-up periods ranging from 2.3 to 120 months. Conclusion It was concluded that the bariatric surgery may have improved the glycemic and metabolic outcomes. Therefore, the results underscore the value of incorporating bariatric surgery into diabetes care strategies, highlighting its potential to enhance long-term diabetes management and mitigate the risk of complications.

Surgery and Minimally Invasive Devices for the Treatment of Obesity in Children and Adolescents: A Systematic Review and Meta‐Analysis

2025-06-22
Francesco Maria Carrano , Eleonora Allocati , Rita Banzi +7 more | Obesity Reviews
ABSTRACT Background Childhood obesity is a global health challenge linked to metabolic, cardiovascular, and psychosocial complications. While lifestyle interventions represent the key strategy for obesity management, metabolic and bariatric surgery 
 ABSTRACT Background Childhood obesity is a global health challenge linked to metabolic, cardiovascular, and psychosocial complications. While lifestyle interventions represent the key strategy for obesity management, metabolic and bariatric surgery (MBS) has emerged as a therapeutic option for severe obesity. This systematic review with meta‐analysis assessed the effectiveness and safety of MBS and weight management devices in children and adolescents. Methods We included randomized and prospective controlled cohort studies assessing MBS or weight management devices in children and adolescents with obesity, searching PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry through January 2025. Critical outcomes included body mass index (BMI) and weight reduction, adverse events, and incidence or severity of obesity‐related outcomes. Results Seven studies (three RCTs and four non‐RCTs), all involving adolescents undergoing MBS, were included. No studies evaluated children or devices. Meta‐analysis showed that compared with lifestyle intervention, MBS reduced BMI by 11.7 kg/m 2 (95% CI: –13.2 to −10.1; two RCTs, n = 100) and 14.5 kg/m 2 (95% CI: –15.7 to −13.3; three non‐RCTs, n = 307), and weight by 20.9% (95% CI: –23.6 to −18.1; three RCTs, n = 152) and 31.2% (95% CI: –34.3 to −28.0; two non‐RCTs, n = 173). Certainty of evidence was low. One non‐RCT comparing Roux‐en‐Y gastric bypass and sleeve gastrectomy found similar outcomes. Both RCTs and non‐RCTs reported improvements in obesity‐related outcomes. Conclusions Although MBS leads to substantial weight loss and health benefits in adolescents, the risk of complications underscores the need for careful patient selection, surgical expertise, and comprehensive postoperative care. Trial Registration: PROSPERO registration: CRD42023438469

Psychiatric and Cognitive Functioning After Metabolic and Bariatric Surgery: A Systematic Review and Meta‐Analysis

2025-06-22
Emma A. van Reekum , Michael Darcy , Jaslyn Drage +7 more | Obesity Reviews
ABSTRACT Objective To evaluate psychiatric and cognitive functioning after metabolic and bariatric surgery (MBS) with a systematic review and meta‐analysis. To systematically review and meta‐analyze psychiatric and cognitive outcomes following 
 ABSTRACT Objective To evaluate psychiatric and cognitive functioning after metabolic and bariatric surgery (MBS) with a systematic review and meta‐analysis. To systematically review and meta‐analyze psychiatric and cognitive outcomes following metabolic and bariatric surgery (MBS). Methods Six databases were searched. Randomized controlled trials (RCTs) and nonrandomized studies (NRS) of people with obesity comparing MBS with any nonsurgical intervention or control condition were included. Main outcomes included symptoms of depression, anxiety, and non‐normative eating, substance use disorder diagnosis, suicide death, and cognitive performance in attention, memory, and executive function. Evidence certainty was assessed with GRADE. Heterogeneity was explored with subgroup analyses of ≀ 2 years vs. &gt; 2 years post‐intervention. Results There were 79 studies (75 NRS and 4 RCTs) found, including 732,149 people with obesity who underwent MBS, and 7,670,770 who did not. Among RCTs, MBS may improve depressive symptoms (standardized mean difference [SMD] = −0.40, 95% CI −1.04, 0.24; very low certainty). Among NRS, there was low to very low certainty that MBS may improve depressive (SMD = 0.56, 95% CI −0.87, −0.26), anxiety (SMD = −0.60, 95% CI −1.00, −0.19), and non‐normative eating symptoms (SMD = −0.75, 95% CI −0.97, −0.53) and cognitive performance in attention (SMD = −0.72, 95% CI −1.61, 0.17), but not executive function or memory. MBS may slightly increase suicide deaths (1/1000 more people, 95% CI 0 fewer to 3 more; very low certainty) and substance use disorders (4/100 more, 95% CI from 1 to 9 more; low certainty) &gt; 2‐years post‐surgery. Conclusions Compared to nonsurgical conditions, MBS may improve depression, anxiety, non‐normative eating, and attention, but slightly increase suicides and substance use disorders. There was low to very low certainty in most outcomes, therefore additionalhigh‐quality studies are needed to strengthen the evidence base.

Investigating the Role of Metabolic Bariatric Surgery in Achieving Remission of Type 2 Diabetes Mellitus and Evaluating the Effects on Glycemic Control and Metabolic Health

2025-06-22
Maryam Ahmadi , Muhammad Dewan Ojla , Maheen Iqbal +4 more | Cureus

EASO Position Statement: Women with Obesity Across the Reproductive Life - Fertility, Preconception, Pregnancy, Postpartum, and Breastfeeding-

2025-06-21
Francesca Filippi-Arriaga , Nidhi Agarwal , Diana Martins +5 more | Obesity Facts
Obesity management in women presents distinct challenges across their lifespan. However, there is limited evidence or recommendations focused solely on women living with obesity. This European Association for the Study 
 Obesity management in women presents distinct challenges across their lifespan. However, there is limited evidence or recommendations focused solely on women living with obesity. This European Association for the Study of Obesity (EASO) position statement is based on an expert comprehensive review and summary of the available scientific evidence on women living with obesity. It aims to guide the health and medical assessment of these women during their reproductive life (fertility, preconception, pregnancy, postpartum, and breastfeeding). Key Messages: 1. To better diagnose obesity in women beyond BMI, the use of at least one additional anthropometric measure, like waist-to-height ratio (WHtR), is strongly recommended. When available, the use of Bioelectrical impedance vector analysis (BIVA) is encouraged 2. Women with obesity should be offered obesity management counseling and psychological support. 3. Obesity can negatively impact fertility; weight loss of 5-10% over 6 months improves fertility. 4. In women with Polycystic Ovary Syndrome (PCOS), treatment with metformin and GLP-1 receptor agonists or surgery can be considered. 5. Current recommendations for pregestational obesity suggest a Gestational Weight Gain (GWG) of 5-9 kg. Lower GWG targets should be considered, particularly for class II or III obesity. 6. There is limited clinical data on the safety and efficacy of obesity medication during pregnancy or lactation.7. All pregnant women with obesity should be offered prenatal screening for fetal anomalies, with discussion of the potential limitations of diagnostic tests and additional growth ultrasounds offered on an individual basis. 8. All pregnant women with a BMI ≄30kg/m2 should be screened for gestational diabetes in early pregnancy. Measures to prevent preeclampsia should be taken and the need for thromboprophylaxis assessed. 9. Intrapartum fetal surveillance is recommended during active labour.10. Postpartum weight management is needed to mitigate the risk of adverse outcomes for the mother and for subsequent pregnancies. The assessment of appropriate contraceptive methods during the postpartum and breastfeeding period is crucial.

Calibration Bougie Size Selection in Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

2025-06-21
Nozim Jumaev , Oktyabr Teshaev , Iefan Lim +1 more | Obesity Surgery

Weight Recurrence in Individuals Undergoing Bariatric Surgery According to Different Cutoff Points and its Association with Cardiometabolic Risk Variables

2025-06-21
Victor Giovanino Accetta , Alessandra da Silva , SĂŽnia Lopes Pinto | Obesity Surgery

Comparison of early perioperative outcomes of robotic assisted bariatric surgery vs laparoscopic bariatric surgery in a center of excellence

2025-06-20
Jacqui Wise , Mohammed A. Sbeih , Zoha Ahmad +3 more | Surgical Endoscopy

Predicting Weight Loss After Vertical Sleeve Gastrectomy Using a Whole-genome Sequencing–derived Polygenic Risk Score in the All of Us Cohort

2025-06-20
Yu Hou , Daniel B. Leslie , Jinhua Wang +2 more | Annals of Surgery
Objective: To create a genome-wide polygenic risk score (PRS) to improve prediction of a 12-month percent weight-loss (WL) following vertical sleeve gastrectomy (VSG). Background: Variability in post VSG WL is 
 Objective: To create a genome-wide polygenic risk score (PRS) to improve prediction of a 12-month percent weight-loss (WL) following vertical sleeve gastrectomy (VSG). Background: Variability in post VSG WL is not well explained by clinical factors. The All of Us program provides access to a 414,830 short-read whole-genome sequencing (srWGS) resource enabling unbiased discovery of genetic predictors following VSG. Methods: VSG counts, demographic, anthropomorphic and vital sign information were obtained from the linked electronic health record (EHR). The discovery cohort (DC) included participants from version 7 carried into version 8 while the validation cohort (VC) included those newly added to v8. We defined good responders and non-responders as having WL±1SD from the mean. Following quality filtering we applied a two-stage penalized-regression followed by elastic-net logistic regression to identify 1,583 stable variants and derive ÎČ-weights. We then tested this PRS on the DC into a prediction model. Results: We identified 395 participants in the DC and 336 participants in the VC, respectively. Of these VSG, 44 were classified as good responders (≄37% WL) and 55 as non-responders (≀19% WL). In the VC, 55 were classified as good responders and 48 as non-responders. Adding the PRS to models to clinical predictors increased the AUC following logistic regression by 0.03; P &lt;4.3×10⁻Âč⁎, random forest by 0.03; P &lt;9.1×10⁻⁷, decision tree by 0.05; P =1.2×10⁻³, and gradient boosting by 0.08; P &lt;8.3×10⁻Âč⁰. Conclusion: Use of srWGS from AoU can be effectively used to generate PRS to enhance predictive WL accuracy. This work has implications for outcomes of both bariatric surgery and other surgical procedures.

Nursing Care During Sleeve Gastrectomy

2025-06-20
Wei Chen , Xinxiang Fan , Yibin Hao | Journal of Surgery & Anesthesia Research
Currently, the International Body Mass Index defines obesity; morbid obesity refers to BMI&gt;40 obesity or BMI&gt;35 severe obesity and has been combined with obesity-related diseases. With the vigorous development of 
 Currently, the International Body Mass Index defines obesity; morbid obesity refers to BMI&gt;40 obesity or BMI&gt;35 severe obesity and has been combined with obesity-related diseases. With the vigorous development of bariatric surgery at home and abroad, more and more patients with morbid obesity received bariatric surgery and achieved good weight loss [1]. laparoscopic gastric sleeve resection is a new weight loss surgery style that has appeared on the international scene in recent years, its trauma is a small, simple surgical operation, with fewer complications, can maintain the essential structural normal function of the gastrointestinal tract after operation, without any complications [2,3]. Laparoscopic gastric sleeve resection is a new type of weight loss surgery that has emerged internationally in recent years. Which is characterized by minor trauma, simple surgical operation, fewer complications, and the ability to maintain the basic standard structure and function of the gastrointestinal tract after the operation [4,5].

Accuracy matters: estimating gastric volume in patients with gastric sleeve using a novel equation

2025-06-20
Ryan S. D’Souza , Alexander Doyal , Jacob R Wrobel +1 more | Regional Anesthesia & Pain Medicine

Comment on: Freedom of Choice in the USA: Patient Autonomy Is Driving Decision-Making in Bariatric Surgery

2025-06-20
Xu Qi | Obesity Surgery

Differential Impact of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Postoperative Constipation: Insights for Optimized Patient Care

2025-06-19
Ä°lyas KudaƟ , Fatih BaƟak , Yahya Kemal ÇalÄ±ĆŸkan +5 more | Bariatric Surgical Practice and Patient Care

Identifying Preoperative Risk Factors for 30-Day Emergency Department Visits After Bariatric Surgery: A Predictive Model Approach

2025-06-19
Pawan Bhandari , M. Affan Badar , Christopher Kluse +1 more | Arabian Journal for Science and Engineering

Characterizing advanced stapling technique using objective performance indicators in robotic-assisted sleeve gastrectomy: a retrospective cohort study

2025-06-19
Sarah Choksi , Bishaka Hirachan , Mattia Ballo +7 more | Surgical Endoscopy

Editorial Opinion: Methodological Rigor in Metabolic and Bariatric Surgery Research—Learning from History

2025-06-19
Ala Wafa , Mohammad Kermansaravi , Ricardo Cohen | Obesity Surgery

Modelled Weight Loss in an English Population Eligible for Bariatric Surgery: A Retrospective Open Cohort Study

2025-06-18
Dimitri J. Pournaras , JoĂŁo Diogo Da Rocha Fernandes , Sara Holloway +3 more | Advances in Therapy

Re-evaluating the concept of remission in type 2 diabetes: a call for patient-centric approaches

2025-06-18
Helen Dallosso , Dimitris Papamargaritis , Vanita R. Aroda +2 more | The Lancet Diabetes & Endocrinology

Dehiscence of Cruroplasty after Gastric Sleeve: Prevention Based on Proper Surgical Technique

2025-06-18
Yeray Trujillo Loli , Carlos Centeno , Armando Romeo +3 more | Journal of Laparoendoscopic & Advanced Surgical Techniques
Objective: To identify the safest and most effective knot-tying sequences for cruroplasty after gastric sleeve surgery, aiming to reduce recurrence risk. Materials and Methods: A total of 38 knot-tying sequences 
 Objective: To identify the safest and most effective knot-tying sequences for cruroplasty after gastric sleeve surgery, aiming to reduce recurrence risk. Materials and Methods: A total of 38 knot-tying sequences were tested using a dynamometer and nonabsorbable sutures. These were divided into four groups: Silk 0 (8 sequences), Silk 2/0 (12), Nylon 1 (12), and Polypropylene 2/0 (14). Each sequence was randomly selected and evaluated based on the average tensile strength of 10 tied knots. Results: For Silk 2/0, the strongest sequences were H3H2a (46.39 N) and H2H1aH1aH1aH1a (45.89 N); the weakest were SSbSb (22.28 N) and SSbSbSb (24.18 N). For Silk 0, H3H2a (72.44 N) and H3H2s (70.48 N) were most resistant, while H1H1sH1sH1sH1s (56.6 N) had the lowest strength. With Nylon 1, H2H1sH1sH1sH1sH1s and H2H1aH1aH1aH1aH1aH1a had the highest strengths; SSbSbSb (29.38 N) was weakest. Polypropylene 2/0 sequences showed consistent strength, with H2H1aH1aH1aH1a (48.91 N) being the strongest. Conclusions: For Silks 0 and 2/0, at least three half-knots (H1H1H1) are recommended. Starting with a double knot (H2) offers no added benefit. Slip knots should include a minimum of five throws. For Nylon 1, six-throw sequences are optimal; fewer than four throws are not recommended. Polypropylene 2/0 showed uniform performance across sequences. Knot symmetry did not significantly affect strength in any group. All recommended sequences exceed the 43 N threshold needed to prevent cruroplasty dehiscence under normal intra-abdominal pressures.

Mortality Related to Bariatric Surgery (<scp>MORSE</scp> Study): A Retrospective, International Collaborative Audit

2025-06-18
Vignesh Balasubaramaniam , Geoffrey Yuet Mun Wong , Alessandro Martinino +7 more | Clinical Obesity
ABSTRACT Bariatric surgery is associated with low but definite early and late mortality. This study aims to further understand early (≀ 90 days) and delayed (&gt; 90 days) mortality related 
 ABSTRACT Bariatric surgery is associated with low but definite early and late mortality. This study aims to further understand early (≀ 90 days) and delayed (&gt; 90 days) mortality related to bariatric surgery. This is a retrospective collaborative audit of patients who had undergone bariatric surgery and developed complications that ultimately led to death. Individuals who were 18 years or older and had undergone bariatric surgery (primary, revisional, and endoscopic procedures) and subsequently died within 90 days or after 90 days following the surgery between 1 January 2022, and 31 December 2022. A descriptive analysis was conducted. About 30 centres from 21 countries submitted data on 82 patients where patient death was deemed to be related to bariatric surgery. Mortality within 90 days post‐surgery was observed in 58 individuals (70.7%), while 24 patients (29.3%) died after this period. Causes of mortality after SG include GI leak, PE, respiratory infection, and malnutrition. Causes of mortality after RYGB include GI leak, coronary heart disease, and bleeding. Reported common causes of early mortality in this study were gastrointestinal leaks, bleeding, coronary heart disease, and pulmonary embolism. Reported common causes of delayed mortality were gastrointestinal leaks and malnutrition. This study characterises patients where death was attributed to a bariatric procedure and identifies common causes of death in these patients. This could aid development of strategies for preventing and managing these complications in the future.

Trajectories of body mass index and diabetes mellitus risk among elderly Chinese adults: A 10‐year longitudinal study

2025-06-17
Yan Guo , Xiaoyu Zhang , Wei Li +3 more | Diabetes Obesity and Metabolism
Abstract Aims This study aimed to identify trajectories of body mass index (BMI) for elderly Chinese adults, evaluate the impact of BMI trajectories on the risk of diabetes mellitus (DM) 
 Abstract Aims This study aimed to identify trajectories of body mass index (BMI) for elderly Chinese adults, evaluate the impact of BMI trajectories on the risk of diabetes mellitus (DM) or impaired fasting glucose (IFG) among normoglycaemic elderly and compare the incidence of progression to DM and reversion to normoglycaemia between BMI trajectories among IFG elderly to prevent the occurrence of diabetes. Materials and Methods This study included 148 970 participants. Group‐based trajectory modelling was used to identify BMI trajectories. Cox proportional hazards regression models were used to examine the associations between BMI trajectories and the incidence of DM, IFG and reversion to normoglycaemia. Results A total of six patterns of trajectory were identified: minor decrease, sharply decrease, stable, slight increase, moderate increase and significant increase among 148 970 elderly Chinese adults. For normoglycaemic elderly, compared with normal weight‐stable trajectory, the trajectories with higher DM risk are the obese‐pronounced decrease group, the obese‐marginal increase group, and the obese‐minor decrease group. The adjusted hazard ratios (HRs) were: 2.70 (95% confidence interval [CI]: 2.35, 3.11), 2.55 (95% CI: 2.28, 2.86) and 2.41 (95% CI: 2.24, 2.60), respectively. The trajectories with higher IFG risk are the obese‐marginal increase group, the obese‐minor decrease group and the overweight‐moderate increase group, with adjusted HRs of 2.26 (95% CI: 2.08, 2.45), 1.96 (95% CI: 1.86, 2.07) and 1.91 (95% CI: 1.79, 2.04), respectively. Conclusions Among 148 970 participants, normoglycaemic elderly with increased BMI trajectories showed elevated DM and IFG risks in groups with underweight and normal weight. Regardless of the BMI trajectory, the risk of DM was increased in both the obese and overweight groups. For IFG elderly, the highest DM incidence was presented in the decreasing trajectories.

Impact of Bariatric Metabolic Surgery on Cardiovascular, Kidney, and Mortality Outcomes Among Adults with Obesity and Chronic Kidney Disease Across Different Time Frames

2025-06-17
Yu-Min Lin , Chia‐Li Kao , Kuo-Chuan Hung +4 more | Obesity Surgery

The Impact of Endoscopic Gastric Remodeling (EGR) on Gastroesophageal Reflux Disease (GERD)

2025-06-17
Pichamol Jirapinyo , David J. Leung , Walter W. Chan +1 more | Clinical and Translational Gastroenterology
Introduction: Sleeve gastrectomy is associated with an increased incidence of gastroesophageal reflux disease (GERD). In contrast, the impact of endoscopic gastric remodeling (EGR) on GERD symptoms remains unclear. Methods: This 
 Introduction: Sleeve gastrectomy is associated with an increased incidence of gastroesophageal reflux disease (GERD). In contrast, the impact of endoscopic gastric remodeling (EGR) on GERD symptoms remains unclear. Methods: This prospective study included patients who underwent EGR and completed validated GERD-related patient-reported outcome questionnaires at baseline and 12 months post-procedure. Results: Fifty patients were included. At 12 months post-EGR, both GERD-Q and Reflux Symptom Index scores significantly improved. Proton pump inhibitor (PPI) use decreased from 38% at baseline to 20% at 12 months (p=0.047). The presence of a hiatal hernia at baseline was associated with greater symptom improvement. Discussion: EGR improves both typical and atypical GERD symptoms and reduces PPI dependence. It may represent a preferable treatment option for patients with obesity and concomitant GERD.

Comparing Anastomotic Leak Rate Between Robotic and Laparoscopic Bariatric Procedures: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database Study

2025-06-17
Alexandria Jones , Alexander Hall , Kalyana C. Nandipati | Obesity Surgery

Quantifying malabsorption after Roux-en-Y gastric bypass and sleeve gastrectomy using near infrared spectroscopy

2025-06-17
Rutger J. Franken , Max Zwartjes , Ashley Senff +4 more | Research Square (Research Square)
<title>Abstract</title> <bold>Background</bold>: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common bariatric procedures that lead to substantial and sustained weight loss. RYGB includes both a restrictive and malabsorptive component 
 <title>Abstract</title> <bold>Background</bold>: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common bariatric procedures that lead to substantial and sustained weight loss. RYGB includes both a restrictive and malabsorptive component due to anatomical rerouting, whereas SG is considered primarily restrictive. This study aimed to quantify differences in energy and fat absorption between both procedures using near-infrared spectroscopy (NIRS). <bold>Methods:</bold> Female patients, 12–24 months post-RYGB or SG, followed a strictly controlled, tailor-made diet for six days. Faecal samples collected over the final three days were analysed using NIRS to assess energy and fat malabsorption. Physical activity and stool consistency were also evaluated. <bold>Results:</bold> Twenty-nine patients were initially included; one RYGB patient was excluded due to implausibly high reported energy intake leaving 14 RYGB and 14 SG patients. We found higher (<italic>p</italic> = 0.03) malabsorption in patients after RYGB (194.8 malabsorbed kcal, 13.2 %) as compared to patients after SG (111.7 malabsorbed kcal, 7.6 %). Furthermore, in the RYGB group, malabsorbed fat was higher (<italic>p</italic> = 0.01) with 9.7 g (15.4 %) malabsorbed as compared to 3.9 g (6.1 %) malabsorbed in SG. Even when adjusting for percentage weight loss, both differences remained statistically significant. <bold>Conclusion:</bold> Fat and energy malabsorption are significantly higher following RYGB compared to SG. However, the differences are relatively modest and do not appear to be directly proportional to the reduction in functional intestinal length exposed to nutrients.

Comment on “Analysis of intra- and postoperative interventional endoscopic measures in 3000 bariatric surgical procedures over 15 years: a single-center study”

2025-06-17
Sumesh Prasad Sah , Renu Sah | Updates in Surgery

Seven Years Follow-Up after Sleeve Gastrectomy in Adolescents

2025-06-16
Mohamed Ali Shehata , Wael Abosena , A. Elhaddad +1 more | Obesity Surgery
Abstract Background Adolescent obesity is a growing global health challenge, often accompanied by serious comorbidities. This study evaluates the long-term outcomes of laparoscopic sleeve gastrectomy (LSG) in adolescents, focusing on 
 Abstract Background Adolescent obesity is a growing global health challenge, often accompanied by serious comorbidities. This study evaluates the long-term outcomes of laparoscopic sleeve gastrectomy (LSG) in adolescents, focusing on weight loss, comorbidity resolution, and post-surgical complications over a seven-year period. Materials and Methods A retrospective analysis was conducted on 63 adolescents (mean age: 15.4 ± 2.39 years) at Tanta university hospitals, Egypt, who underwent LSG between 2014 and 2015. Outcomes assessed included body mass index (BMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), excess BMI loss (%EBMIL), comorbidity resolution, and gastric volumetry at 1, 3, 5, and 7 years postoperatively. Results Mean BMI declined from 48.1 ± 10.55 to 29.3 ± 8.53 kg/m 2 , with %TWL peaking at 32.9% at year 3 and moderating to 29.1% by year 7. Significant reductions were observed in diabetes (34.9% to 11.1%), hypertension (60.3% to 12.7%), obstructive sleep apnea (39.7% to 6.4%), GERD (25.4% to 4.8%), and dyslipidemia (42.9% to 3.2%) (all p &lt; 0.05). The overall complication rate was low (7.9%), and 14.3% required revisional surgery. Among married participants, 76.9% achieved successful pregnancies. Conclusions LSG is a safe and effective long-term intervention for adolescents with severe obesity, yielding sustained weight loss and significant comorbidity remission, with favorable fertility outcomes among married patients. Despite modest weight regain and a limited rate of reoperations, outcomes support LSG as a durable option. Long-term follow-up and individualized care remain essential.

Paragastric Neural Blockade Effectively Controls Visceral Pain After Primary Laparoscopic Sleeve Gastrectomy

2025-06-16
Dongwon Lim , Yoona Chung , Bomina Paik +1 more | Obesity Surgery

Comparativa entre la manga gĂĄstrica y el bypass gĂĄstrico como tratamiento para la obesidad

2025-06-16
Carol Solange Toapanta-Montesdeoca , IvĂĄn Patricio Loaiza Merino | Deleted Journal
Obesity is a chronic, multifactorial disease that is associated with a significant increase in metabolic and cardiovascular comorbidities, underscoring the need for effective treatments. The objective of this research is 
 Obesity is a chronic, multifactorial disease that is associated with a significant increase in metabolic and cardiovascular comorbidities, underscoring the need for effective treatments. The objective of this research is to compare the effectiveness, safety and long-term results of these procedures through a review of the scientific literature. An electronic search was carried out for scientific articles published from January 2019 to 2024 in the PubMed, Scopus, Web of Science and ScieLO databases. Scientific evidence suggests that the two procedures have different benefits; the choice of each of these has to focus on the criteria given by scientific associations and societies duly recognized worldwide. In conclusion, both gastric sleeve and gastric bypass are effective interventions to treat morbid obesity, with clear benefits in weight loss and improvement of comorbidities. Gastric bypass stands out for offering a faster and more sustained weight reduction, particularly in cases of extreme obesity or severe comorbidities such as type 2 diabetes, although it implies a greater risk of long-term nutritional deficiencies due to its malabsorption component. In contrast, the gastric sleeve, less invasive and with fewer postoperative complications, minimizes the impact on nutrient absorption, although it can exacerbate gastroesophageal reflux. The choice of procedure depends on the specific clinical needs of the patient.

SF-BARI Score for Assessment of Long-Term Results in Patients with BMI ≄ 50 kg/m2 Submitted to Roux-en-Y Gastric Bypass or Sleeve Gastrectomy

2025-06-16
AndrĂ© Costa-Pinho , JoĂŁo AraĂșjo-Teixeira , Sara Rodrigues +4 more | Obesity Surgery

Variations in weight loss and glycemic outcomes after sleeve gastrectomy by race and ethnicity

2025-06-16
Sally M Vanegas , Silvia Curado , Boyan Zhou +7 more | Obesity
Abstract Objective This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial 
 Abstract Objective This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial factors in postsurgical outcomes. Methods This longitudinal study included patients who underwent SG between 2017 and 2020, with follow‐up visits over 24 months. Results Non‐Hispanic Black (NHB) participants had lower %TWL at 3, 12, and 24 months compared with Hispanic (H) and non‐Hispanic White (NHW) participants. Fat mass index was initially lower in NHB, with smaller reductions over time and significant group differences persisting at 24 months. NHB participants had higher baseline fat‐free mass index values; by 24 months, fat‐free mass index values were lower in H participants. Hemoglobin A1c decreased across all groups but remained consistently higher in NHB and H compared with NHW at 24 months. NHB participants reported higher perceived discrimination, sleep disturbance, and perceived stress than H and NHW participants at all time points. Employment status predicted %TWL at 12 months. There was a significant interaction between race and ethnicity and employment status observed at 12 and 24 months, suggesting that employment‐related disparities could impact surgical outcomes. Conclusions NHB participants experienced less favorable outcomes following SG, emphasizing the need for tailored interventions addressing socioeconomic and psychosocial disparities.

Extensive weight loss prior to bariatric surgery is associated with worse outcomes

2025-06-16
John W. Pickering , Marcoandrea Giorgi , Emily Ortega-Goddard +1 more | Research Square (Research Square)
<title>Abstract</title> <bold>Background</bold>: Weight loss has been shown to favorably affect obesity-related comorbid disease. Prior studies have shown that a 10% preoperative weight loss is associated with fewer complications after gastric 
 <title>Abstract</title> <bold>Background</bold>: Weight loss has been shown to favorably affect obesity-related comorbid disease. Prior studies have shown that a 10% preoperative weight loss is associated with fewer complications after gastric bypass surgery. Although the optimal preoperative preparation for bariatric surgery is not standardized, prerequisite weight loss prior to bariatric surgical procedures is often mandated, typically around 10%, and includes a calorie-restrictive preoperative diet. <bold>Objectives</bold>: To evaluate the association between extensive preoperative weight loss and perioperative outcomes in patients undergoing bariatric surgery. <bold>Methods</bold>: To determine optimal weight loss prior to bariatric surgery, we compared patients who lost over 10% of their highest weight preoperatively to patients who did not within the MBSAQIP database from 2015-2021, which included over 1.3 million patients. <bold>Results</bold>: Patients who lost more than 10% of their highest preoperative weight were more likely to experience postoperative complications, including reoperation (1.40% vs 1.21%, p&lt;.001), bleeding (0.85% vs 0.67%, p&lt;.001), emergency department visits (7.11% vs 6.57%, p&lt;.001), and dehydration (3.92% vs 3.61%, p&lt;.001). These differences remained significant with multivariable regression analysis controlling for multiple patient factors and procedure type. Patients who lost more than 10% of their highest preoperative weight were also found to have a lower mortality (0.10% vs 0.08%, p=.04) and readmission (3.92% vs 3.60%, p&lt;.001), however on multivariable regression analysis these findings were not found to be statistically significant. <bold>Conclusion</bold>: While preoperative weight loss prior to bariatric surgery may be beneficial, , over 10% preoperative weight loss is associated with worse outcomes and should be avoided.

Effect of laparoscopic sleeve gastrectomy (LSG) on the erectile function of Egyptian obese men

2025-06-16
Ahmed Lamey , Tamer A. Abouelgreed , Osama M Abdelmoneim +7 more | Archivio Italiano di Urologia e Andrologia
Objective: The primary aim of the study is to identify the effect of laparoscopic sleeve gastrectomy on the erectile function of Egyptian obese men via measurement of subjective feelings measured 
 Objective: The primary aim of the study is to identify the effect of laparoscopic sleeve gastrectomy on the erectile function of Egyptian obese men via measurement of subjective feelings measured by the International Index of Erectile Function questionnaire (IIEF-5) and objective sex hormone test. The secondary aim of the study is to evaluate weight loss changes and changes in other blood test results.Patients and methods: One hundred Egyptian men with morbid obesity (mean BMI 45.5 kg/mÂČ, mean age 37.3 years) who underwent laparoscopic sleeve gastrectomy (LSG), were included retrospectively from the period of January 2022 to January 2024 on this study and 80 completed the 1-year follow-up. All operations were performed by the same surgical team in our hospital. Informed consents were taken from all the patients who were recruited in the study.Results: Significant reductions in comorbidities such as hypertension, diabetes, osteoarthritis, and dyslipidemia were observed after laparoscopic sleeve gastrectomy. Sexual function improved notably in orgasmic function, intercourse satisfaction, and overall satisfaction, along with a significant rise in serum testosterone levels. Patients also experienced substantial decreases in weight, BMI, waist and hip circumference, and improvements in lipid profile, HbA1c, inflammatory markers, and sex hormones. No severe complications or mortality were reported during the study period. Conclusions: A significant enhancement in the erectile function was observed in obese Egyptian men following LGS. This improvement was evidenced both clinically through increased IIEF scores after surgery and biochemically through increased serum testosterone level.

The impact of reduced intraoperative mean arterial pressure on postoperative hemorrhage in bariatric surgery

2025-06-16
Arturo Estrada , Yeisson Rivero-Moreno , Jinglin Xia +6 more | Surgical Endoscopy
Abstract Background Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial 
 Abstract Background Postoperative hemorrhage (POH) is a life-threatening complication, occurring in 1.3–1.7% of bariatric surgeries and still constitutes a recognized challenge. This study examined the effect of intraoperative mean arterial pressure (MAP) on the development of POH. Methods A retrospective observational study with a case–control design was conducted on adult patients who underwent bariatric surgery between 2015 and 2023 at a high-volume academic center. Intraoperative MAP (including MAP in the last 10 and 30 min) was collected in patients who developed POH. Cases were matched with controls by sex, gender, type of procedure, and ASA classification. Results From 204 participants, 102 patients with POH were matched with 102 controls. The most common procedure performed was Roux-en-Y gastric bypass ( n = 98, 48%), followed by sleeve gastrectomy ( n = 77, 37.7%). Patients with POH had statistically significant lower intraoperative MAP during the last 10 min (92.41 ± 14.25 vs 97.44 ± 14.64, p = 0.014) and 30 min (87.93 ± 12.32 vs 91.93 ± 11.26, p = 0.016) of surgery compared to controls. An intraoperative MAP lower than 90 mmHg in the last 10 min (OR = 2.067, 95% CI = 1.156–3.695), 30 min (OR = 2.231, 95% CI = 1.27–3.919), and whole procedure (OR = 1.834, 95% CI = 1.024–3.285) was associated with increased risk of POH. No significant differences were found in comorbidities, smoking, preoperative laboratory results, history of antiplatelet therapy or anticoagulation use, and operative time between the two groups. Conclusion Our study demonstrates that patients with POH had lower intraoperative MAP during the last 10 and 30 min of surgery. An intraoperative MAP &lt; 90 mmHg was identified as a risk factor for developing POH.

Clinical outcomes of varying age groups following vertical sleeve gastrectomy: a retrospective study using the 2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database in the United States

2025-06-15
Satyam K. Ghodasara , Jana K. Elsawwah , Hyo J. Yang +2 more | Daehan nae'si'gyeong bog'gang'gyeong oe'gwa haghoeji/Journal of minimally invasive surgery
The rising rates of obesity across the United States, particularly among pediatric and elderly patients, have led to more bariatric surgeries among these populations. Previous studies have compared the outcomes 
 The rising rates of obesity across the United States, particularly among pediatric and elderly patients, have led to more bariatric surgeries among these populations. Previous studies have compared the outcomes between pediatric or elderly patients and adult patients, but none have studied all groups together. Therefore, we compared the outcomes of all three age groups following a laparoscopic sleeve gastrectomy. The 2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was utilized to identify pediatric (aged 13-17 years, n = 333), adult (aged 18-65 years, n = 118,444), and elderly (aged 66-80 years, n = 5,646) patients. Analyses were performed with the adult cohort serving as the reference group. Postoperatively, the elderly cohort experienced higher rates of mortality and complications, including sepsis, reoperations, and readmissions. Preoperatively, the elderly cohort also had higher rates of comorbidities, including sleep apnea, gastroesophageal reflux disease, and hypertension. After controlling for all variables, multivariate logistic regression analysis revealed that being pediatric, male, or having a preoperative body mass index (BMI) ≄45 kg/m2 were associated with a BMI decrease of ≄2.5 kg/m2 postoperatively within the 30-day follow-up period. These findings highlight the varying clinical outcomes among age groups of patients undergoing bariatric surgery. The pediatric cohort saw the most significant decrease in postoperative BMI with minimal complications, while the elderly cohort saw the opposite trend.

The Safety and Efficacy of Laparoscopic One Anastomosis Gastric Bypass as a Revision for Laparoscopic Adjustable Gastric Banding and Laparoscopic Sleeve Gastrectomy

2025-06-15
Ehud Berger , Leonid Drober , Ahmad Assalia +1 more | Obesity Surgery

Beyond weight loss: exploring bile acid modulations after bariatric surgery and their impact on type 2 diabetes across 5 years

2025-06-15
John Zhiyong Yang , Michelle Li , Weiyu Zhou +5 more | Obesity
Abstract Objective This study aimed to explore the dynamic role of bile acids (BAs) in metabolic improvements following bariatric surgery, specifically comparing the effects of silastic ring laparoscopic Roux‐en‐Y gastric 
 Abstract Objective This study aimed to explore the dynamic role of bile acids (BAs) in metabolic improvements following bariatric surgery, specifically comparing the effects of silastic ring laparoscopic Roux‐en‐Y gastric bypass (SR‐LRYGB) and laparoscopic sleeve gastrectomy (LSG) on BA composition and clinical parameters over a 5‐year period. Methods A cohort of patients with obesity and type 2 diabetes underwent SR‐LRYGB or LSG. Principal component analysis was performed to evaluate BAs and clinical outcomes. Results Despite significant increases in the first year after surgery, BA levels returned to baseline after 5 years. However, principal component analysis revealed that certain BA profiles may contribute to long‐term metabolic benefits. Conclusions Although total BA levels return to baseline by 5 years after surgery, specific BA profiles, as identified by principal component analysis from oral glucose tolerance test data, are associated with sustained metabolic improvements. SR‐LRYGB is associated with more durable metabolic benefits compared with LSG. However, given the use of the oral glucose tolerance test, which may not fully capture postprandial BA dynamics, further research using mixed‐meal tolerance tests is needed to confirm these findings. image

ROUTINE ENDOSCOPY BEFORE BARIATRIC SURGERY; NECESSITY OR OVERKILL

2025-06-14
Asma Hirani , Ghulam Murtaza , Fahd Adeeb | Journal of medical & health sciences review.
Background: We aim to determine the frequency of patients with abnormal preoperative esophagogastroduodenoscopy (EGD) and factors associated with it in patients undergoing bariatric surgery to assess their impact on surgical 
 Background: We aim to determine the frequency of patients with abnormal preoperative esophagogastroduodenoscopy (EGD) and factors associated with it in patients undergoing bariatric surgery to assess their impact on surgical planning. Methods: A cross-sectional study was conducted at the Department of Surgery at a tertiary care hospital from October 2024 to March 2025. Patients planned for bariatric surgery with age between 16 and 70 years, BMI ≄ 27.5 kg/mÂČ and ASA I-III who consented for preoperative EGD were included. EGD was performed by consultant gastroenterologists for abnormal EGD findings and data was collected by a surgical resident.Results: A total of 159 patients were included in the study, with a preponderance of females 92 (57.9%). The mean age was 39.7 years, and the median BMI was 44.5 kg/mÂČ (IQR 37.90 - 53.60). OSA (50.9%) and hypertension (49.1%) were the most common comorbidities. Abnormal EGD findings were reported in 21/159 (13.2%) patients. Gastritis was the most common finding in 14/159 (8.8%) patients, followed by ulcers in 9/159 (5.7%) patients. Among the 21 patients with abnormal findings, five (23.8%) patients required a change in their planned surgical procedure. Stratified analysis showed that GERD and NSAID use were significantly associated with abnormal EGD findings.Conclusion: Our study suggests that routine EGD is not necessary for all bariatric surgery patients due to the low prevalence of abnormal findings. EGD should be selectively performed in patients with a history of GERD and NSAID use to guide surgical decisions and improve postoperative care.

The effect of 6 months of structured strength or endurance exercise program on weight loss after gastric bypass surgery in a randomized controlled trial

2025-06-14
Stefanie Lehmann , Undine Gabriele Lange , Andreas Oberbach +7 more | Langenbeck s Archives of Surgery
Abstract Purpose To examine the effects of differently structured exercise programs (strength training (ST) vs endurance training (ET) vs a control group (CG)) on glucose metabolism and weight loss following 
 Abstract Purpose To examine the effects of differently structured exercise programs (strength training (ST) vs endurance training (ET) vs a control group (CG)) on glucose metabolism and weight loss following Roux-en-Y Gastric Bypass (RYGB). Methods After RYGB, patients were randomized to a standardized ST or ET program or a control group, the intervention started within 28 days. Outcomes at 6 months were glucose and lipid metabolism, anthropometrics, inflammation, and quality of life. Results 93 patients were randomized (30 in ST and 31 in ET, 32 in CG; 28% with type 2 diabetes mellitus, 8.5% insulin-dependent). Total weight was − 2.5 kg (95% CI − 4.7 to − 0.4, p = 0.023) lower in pooled intervention group (PIG) and fat mass according to bioelectrical impedance analysis was − 3.0 kg (95% CI − 5.0 to − 1.0, p = 0.0037) lower in the PIG. Fat-free mass decreased by − 4.2 kg with no difference between the groups. The primary endpoint, glucose concentration after a 2 h oral glucose tolerance test, did not differ between the PIG and the CG, − 0.29 mmol/L (95% CI − 1.22 to 0.63, p = 0.54). Similarly, we did not detect any differences in lipid metabolism, inflammation, and quality of life between the groups. Conclusion In our study, we found that an additional exercise training 6 months postoperatvely- independent of the type of training- resulted in greater weight loss and loss of fat mass. However, it had no effect on glucose/lipid parameters or inflammation beyond the surgery itself.

Implementation and Evaluation of a Weight Management Programme for Overweight or Obese Pregnant Women: &lt;i&gt;A Randomised Controlled Trial&lt;/i&gt;

2025-06-13
Elahe Banafshe , Nahid Javadifar , Zahra Abbaspoor +2 more | Sultan Qaboos University medical journal

Place de la chirurgie bariatrique dans le traitement du diabĂšte de type 2

2025-06-13
Pierre Bel Lassen , CĂ©cile Ciangura , J. Aron-Wisnewsky | EMC - Endocrinologie - Nutrition