Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · May 2008
Review Meta AnalysisReview of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding.
In a prior systematic review and meta-analysis of the large body of literature describing the laparoscopic adjustable gastric band (LAGB), outcomes for the Swedish Adjustable Gastric Band (SAGB) and Lap-Band (LB), in particular, were reviewed. This article summarizes those results and discusses them in relation to the 3 other published bariatric surgery meta-analyses (JAMA 2004;292:1724-37; Ann Intern Med 2005;142:547-59; and Surgery 2007;142:621-32). ⋯ In the SAGB and LB meta-analysis at 1, 2, and 3 years, weight loss, resolution of diabetes and hypertension, and adverse events appeared equivalent. All meta-analyses that assessed weight loss found that bariatric surgery produced clinically significant reductions in excess weight across procedures in the short term. One meta-analysis found that bariatric surgery produced significantly more weight loss than medical treatment in patients with BMI >40 kg/m2 in the short term, with malabsorptive procedures producing the greatest weight loss. All studies reporting on comorbidities showed significant resolution or improvement of type 2 diabetes mellitus ([T2DM] > or =60%), hypertension (> or =43%), and dyslipidemia (> or =70%). In one meta-analysis, surgery was found to be superior to medical therapy in resolving T2DM, hypertension, and dyslipidemia. Sleep apnea was significantly resolved/improved in > or =85% across procedures in the one meta-analysis that addressed this comorbidity. One meta-analysis found no differences in AEs between procedures; however, the laparoscopic approach was associated with significantly reduced AEs. In the 4 meta-analyses, mortality was low (.1%-1.11%) for all procedures. Bariatric surgery was observed to be a safe and highly effective therapy for morbid obesity. Heterogeneity in nomenclature, study methods, statistical detail, definitions of weight-loss success and comorbid disease resolution, and completeness of data sets did not allow for comparison of some variables. Initiatives including the Iowa Bariatric Surgery Registry (IBSR), the Longitudinal Assessment of Bariatric Surgery (LABS) consortium, the Surgical Review Corporation (SRC) Center of Excellence initiative, and the Bariatric Outcomes Longitudinal Database [BOLD] are working to improve data standardization, which, in turn, will facilitate summary and comparison of bariatric surgery outcomes.
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Surg Obes Relat Dis · May 2008
Comparative StudyShort-term outcomes for super-super obese (BMI > or =60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass.
We previously reported significantly longer operating room times and a trend toward increased complications and mortality in the super-super obese (body mass index [BMI] > or =60 kg/m(2)) early in our experience with laparoscopic Roux-en-Y gastric bypass. The goal of this study was to re-examine the short-term outcomes for super-super obese patients undergoing weight loss surgery at our high-volume bariatric surgery center well beyond our learning curve. ⋯ Super-super obese patients required longer total operating room times, a longer hospital length of stay, and were more likely to be discharged to chronic care facilities than were patients with a BMI <60 kg/m(2); however, the in-hospital mortality was similar for both groups.
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Surg Obes Relat Dis · May 2008
Comparative StudyEffect of Center of Excellence requirement by Centers for Medicare and Medicaid Services on practice trends.
To report the effect of the American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence designation in Michigan on our practice trends and patient populations. As of February 2006, weight loss surgery for Medicare beneficiaries are reimbursed when procedures are performed at American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence. ⋯ The Centers for Medicare and Medicaid Services requirements for Centers of Excellence designation resulted in a significant increase in the Medicare case load within our institution. This population tended to be older and more complex, with longer operative times. The changes present new challenges in patient care, including the coordination of care for the multiple co-morbidities of older obese patients with a multispecialty care team.
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Surg Obes Relat Dis · May 2008
Comparative StudyIncidence and management of enteric leaks after gastric bypass for morbid obesity during a 10-year period.
To describe the incidence, etiology, outcomes, and management of enteric leaks in patients who had undergone open or laparoscopic gastric bypass. ⋯ Enteric leak is a significant complication after gastric bypass. Prompt treatment should be based on clinical suspicion, because contrast and cross-sectional imaging studies might not be reliable diagnostic tests. A laparoscopic index procedure might be associated with an earlier diagnosis.
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Surg Obes Relat Dis · May 2008
Comparative StudyPreoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Success with preoperative weight loss (PWL) is often mandated by the bariatric team to assess patient compliance and has been suggested to correlate with improved postoperative weight loss outcomes. ⋯ The results of our study have shown that weight loss before laparoscopic Roux-en-Y gastric bypass is not mandatory and might deter patients from considering weight loss surgery. Laparoscopic Roux-en-Y gastric bypass can be performed safely with equivalent co-morbidity resolution and %EWL regardless of PWG or PWL.