Obesity surgery
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This study purposed to explore the impact of hospital volume and surgeon volume on hospital resource utilization after bariatric surgery and to identify the predictors of length of stay (LOS) and hospital treatment cost in a nationwide population in Taiwan. ⋯ The data suggest that annual surgical volume is the key factor in hospital resource utilization. The results improve the understanding of medical resource allocation for this surgical procedure and can help to formulate public health policies for optimizing hospital resource utilization for related diseases.
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Meta Analysis
The impact of hospital and surgeon volume on clinical outcome following bariatric surgery.
The dramatic rise in the prevalence of obesity worldwide has led to the rapid growth of bariatric surgery. The aim of this pooled analysis is to evaluate the relationship between institutional and surgeon volume and outcomes following bariatric surgery. Medical, Embase, trial registries, conference proceedings and reference lists were searched for trials comparing clinical outcome following bariatric surgery at high and low volume hospitals and by high and low volume surgeons. ⋯ There were insufficient data for conclusive statistical analysis of length of hospital stay. This pooled analysis does suggest a benefit in the centralisation of bariatric surgery to high volume institutions and surgeons with respect to mortality and morbidity. Future high-powered studies with adjustment for procedural and patient case mix are required to further define the volume-outcome relationship in bariatric surgery.
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Comparative Study
Sleeve gastrectomy plus side-to-side jejunoileal anastomosis for the treatment of morbid obesity and metabolic diseases: a promising operation.
The continuing need for simple, safe, and effective procedures led us to design a new operation for treating morbid obesity. ⋯ Sleeve gastrectomy plus side-to-side jejunoileal anastomosis appears to be a simple, considerably safe, and effective procedure for treating obesity and its metabolic comorbidities.
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The effectiveness and safety of the different bariatric surgical procedures currently available depend, partly, on the characteristics of the populations under study, the technical approach, the expertise of surgical teams, and on institutional factors. To evaluate the effectiveness and safety of these procedures, we compared the surgical results for biliopancreatic diversion surgery versus laparoscopic gastric bypass and sleeve gastrectomies performed in our institution. ⋯ Bariatric surgery in our institution has dramatically shifted from systematic biliopancreatic diversion to a tailored laparoscopic gastric bypass or sleeve gastrectomy approach, which has made it possible to reduce hospital stay and mortality rates.
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Roux-en-Y gastric bypass (RYGB) surgery causes profound changes in secretion of gastrointestinal hormones and glucose metabolism. We present a detailed analysis of the early hormone changes after RYGB in response to three different oral test meals designed to provide this information without causing side effects (such as dumping). ⋯ Within 2 weeks after RYGB, we found an increase in insulin secretion and insulin sensitivity. Responses of appetite-regulating intestinal hormones changed dramatically, all in the direction of reducing hunger.