Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Jan 2010
Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis.
To analyze the socioeconomics of the morbidly obese patient population and the impact on access to bariatric surgery using 2 nationally representative databases. Bariatric surgery is a life-changing and potentially life-saving intervention for morbid obesity. Access to bariatric surgical care among eligible patients might be adversely affected by a variety of socioeconomic factors. ⋯ Socioeconomic factors play a major role in determining who does and does not undergo bariatric surgery, despite medical eligibility. Significant disparities according to race, income, education level, and insurance type continue to exist and should prompt focused public health efforts aimed at equalizing and expanding access.
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Surg Obes Relat Dis · Jan 2010
Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2?
Biliopancreatic diversion with or without the duodenal switch (BPD-DS) is a major bariatric procedure. The morbidity and mortality are likely to increase with an increasing body mass index (BMI), especially when > 50 kg/m(2). Controversy exists regarding the potentially increased risks of a single-stage procedure compared with the risks of sleeve gastrectomy first followed by the malabsorptive procedure after an initial weight loss. ⋯ Single-stage BPD-DS in the super obese appears to be a relatively safe procedure with a low rate of conversion when a laparoscopic approach is used. Although from the published data, the morbidity and mortality are increased for super obese patients, especially men, the BMI itself cannot be considered a contraindication for single-stage BPD-DS, because other factors such as surgical experience also influence the outcome. Despite these variables, performing a sleeve gastrectomy first should be considered for heavier, male, and at-risk patients.
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Surg Obes Relat Dis · Nov 2009
Comparative StudyBariatric surgery and progression of chronic kidney disease.
Obesity is an independent predictor for the development and progression of chronic kidney disease (CKD). The effect of weight reduction on the progression of kidney disease in patients with pre-existing CKD is unclear. ⋯ The renal function of patients with CKD might improve after bariatric surgery. Larger and long-term studies are warranted to further analyze the effect of bariatric surgery on proteinuria and hard end-points such as the development of end-stage renal disease.
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Surg Obes Relat Dis · Nov 2009
Comparative StudyCardiac remodeling after substantial weight loss: a prospective cardiac magnetic resonance study after bariatric surgery.
Obesity is a risk factor for left ventricular (LV) hypertrophy and excess cardiovascular disease and mortality. Substantial weight loss is associated with a decrease in cardiovascular mortality. Using volumetric cardiovascular magnetic resonance (CMR) imaging, we studied changes in cardiac anatomy and systolic function in women undergoing substantial weight loss in a university hospital. ⋯ In morbidly obese women, substantial weight loss was associated with a reduction of LV and RV mass. The decrease in LV mass was linearly related to the reduction in BMI, independent of changes in blood pressure, and might partially explain the reduction in cardiovascular mortality associated with substantial weight loss. The BMI was a predictor of LV mass in this population.