ContextAbout 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.ObjectiveTo determine the impact of bariatric surgery on weight loss, operative
mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia,
hypertension, and obstructive sleep apnea).Data Sources and Study SelectionElectronic 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.Data ExtractionA 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).Data SynthesisA 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 (≤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.ConclusionsEffective 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.

https://jamanetwork.com/journals/jama/articlepdf/199587/JRV40082.pdf

Bariatric surgery: a systematic review and meta-analysis.

CONTEXT\nAbout 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.\n\n\nOBJECTIVE\nTo determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).\n\n\nDATA SOURCES AND STUDY SELECTION\nElectronic 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.\n\n\nDATA EXTRACTION\nA 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).\n\n\nDATA SYNTHESIS\nA 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.\n\n\nCONCLUSIONS\nEffective 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. A systematic review and meta-analysis

This meta-analysis on surgical treatment of obesity supports the American College of Physicians' clinical guideline in this issue. Surgery is more effective than nonsurgical treatment for weight lo...

http://www.paxysarkia.net/Download/Article_metaanalysis_surgical%20treatment%20of%20obesity.pdf

Meta-analysis: surgical treatment of obesity.

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<.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<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days
in 2002 (P<.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.

https://jamanetwork.com/journals/jama/articlepdf/201708/joc50128.pdf

Trends in Bariatric Surgical Procedures

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 ga

/pdf/weight-loss-appetite-suppression-and-changes-in-fasting-and-5fktq4g9hn.pdf

Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study

Background: This paper evaluates biliopancreatic diversion combined with the duodenal switch, forming a hybrid procedure which is a combination of restriction and malabsorption. Methods: The evaluation is of the first 440 patients undergoing this procedure who had had no previous bariatric surgery. The mean starting weight was 183 kg, with 41% of our patients considered super morbidly obese (BMI > 50). Results: There was an average maximum weight loss of 80% excess weight by 24 months postoperation; this continued at a 70% level for 8 years. Major complications were found in almost 9% of the cases. There were two perioperative deaths, one from pulmonary embolism and one from acute pulmonary obstruction. There were 36 type II diabetics, all of whom have discontinued medication following the surgery. Seventeen revisions were performed to correct excess weight loss and low protein levels. There have been no marginal ulcers, no cases of dumping syndrome, no foreign material used, and the procedure is a pyloric saving procedure which is functionally reversible. Conclusions: This operation has vastly improved the lives of seriously obese patients with many co-morbidities. All type II diabetics have essentially been cured of their disease. The procedure was tolerated well and patients are quite satisfied. There was minimal regain of weight with this method.

https://www.soard.org/article/S1550-7289(05)00424-7/pdf

Biliopancreatic Diversion with a Duodenal Switch

The BPD/DS, if properly performed, has the best long-term weight loss of any bariatric operation. It is easy to reverse or revise, has the least marginal ulcers, cures the highest percentage of co-morbidities, has the least failures, and permits normal although smaller meals. It is our opinion that the BPD/DS should be considered as the gold standard bariatric operation.

The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years

The authors describe a vertical banded gastroplasty with complete division of the staple-line performed via the laparoscope

Douglas W Hess

Papers

Biliopancreatic Diversion with a Duodenal Switch

The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years

Laparoscopic Vertical Banded Gastroplasty with Complete Transection of the Staple-Line