Showing papers by "Henry Buchwald published in 2004"

Bariatric surgery: a systematic review and meta-analysis.

Abstract: 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.

Bariatric surgery worldwide 2003.

Abstract: Background: There is a world epidemic of overweight, obesity, and morbid obesity, encompassing 1.7 billion people. Bariatric surgery today is the only effective therapy for morbid obesity. Methods: E-mail requests for information were sent to the presidents of the national societies of the 31 International Federation for the Surgery of Obesity (IFSO) nations, or national groupings, plus Sweden. Responses were tabulated; calculation of relative prevalence of specific procedures was done by weighted averages. Results: Responders were 26 of 32 (81%) for the general questions and 24 of 32 (75%) for the question on specific operative percentages. In the year 2002-2003, 146,301 bariatric surgery operations were performed by 2,839 bariatric surgeons; 103,000 of these operations were performed in USA/Canada by 850 surgeons. The earliest start date for bariatric surgery was 1953 in the USA; IFSO was founded in 1995. In the year 2002-2003, 37.15% of operations were open; 62.85% laparoscopic. The 6 most popular procedures by weighted averages were: laparoscopic gastric bypass, 25.67%; laparoscopic adjustable gastric banding, 24.14%; open gastric bypass, 23.07%; laparoscopic long-limb gastric bypass, 8.9%; open long-limb gastric bypass, 7.45%; and open vertical banded gastroplasty, 4.25%. Pooling open and laparoscopic procedures, relative percentages were: gastric bypass, 65.11%; gastric banding, 24.41%; vertical banded gastroplasty, 5.43%; and biliopancreatic diversion/duodenal switch, 4.85%. Categorizing into restrictive/malabsorptive, purely restrictive, and primarily malabsorptive, the relative distribution of procedures was 65.11%, 29.84%, and 4.85%, respectively. The number of countries performing gastric banding was 23 (95%), gastric bypass 21 (88%), vertical banded gastroplasty 19 (79%), and biliopancreatic diversion/duodenal switch 16 (67%). Purely restrictive procedures were performed in 24 (100%) of the countries, restrictive/malabsorptive in 21 (88%), and primarily malabsorptive in 18 (75%). Conclusions: Bariatric surgery is expanding exponentially to meet the global epidemic of morbid obesity. Operative procedures in bariatric surgery are in flux and specific geographic trends and shifts are evident. Yet, of the patients qualifying for surgery, only about 1% are receiving this therapy – the only effective treatment currently available.

Gastric stimulation: A new paradigm for management of morbid obesity

Abstract: The introduction of gastric pacing into bariatric surgery heralds a new paradigm and represents a novel approach to the management of the disease of morbid obesity. This innovation extends today's standard concepts of inducing weight loss by gastric restriction and intestinal malabsorption to satiety induction by physiologic or biochemical mechanisms elicited by repetitive electronic gastric stimulation. To date, gastric pacing has been demonstrated to reduce appetite, increase satiety, inhibit gastric motility, and directly affect central nervous system mechanisms and hormones related to satiety and/or appetite. Current clinical studies of gastric pacing with the Transneuronix Implantable Gastric Stimulator (IGS®) system have shown the laparoscopic placement of bipolar electrode leads into the wall of the stomach, and the subcutaneous implantation of a battery-powered pacer, to be extremely safe and relatively easy. Further, this form of bariatric therapy allows for percutaneous adjustment of the pacer and its effect on the gastric wall, with the opportunity to temporarily discontinue therapy. The weight loss outcomes of the clinical trials with this system to date have been mixed and have clearly demonstrated the need for preoperative patient selection. The fact that only certain well-

Improvement of Blood Oxygen Diffusion Capacity and Anginal Symptoms by Cholesterol Lowering with Simvastatin

Abstract: Objective:To assess the hypothesis that a cholesterol-lowering regimen with sim- vastatin would improve red blood cell (RBC) oxygen diffusion,and that such improvement would correlate with the intensity of anginal symptoms and with exercise electrocardiogram (ECG) changes. Methods:Desaturated venous blood samples from 18 hypercholesterolemic volunteer subjects with exertional chest pain were collected before and after they took 40 mg of simvastatin daily for 12 weeks.Blood samples were standard- ized to a hematocrit of 40% and a hemoglobin correction factor of 13.5