Gastric bypass is an extensive gastric exclusion operation used in patients who are more than twice their ideal weight. Most of the early postoperative deaths observed in 3% of 442 patients during the initial 9 years, could have been prevented by more attention to operative technique and early recognition and correction of leaks when they occurred. The best weight loss can be produced by adherence to three components of the operation: 1) Bypass of stomach and duodenum, 2) a small fundic segment and 3) a small (12 mm diameter) gastroenterostomy stoma. The average patient of 142 kg can expect to have a weight of around 107 kg at 1 year 103 kg at 5 years. Revision of a large stoma to a smaller (9 mm) diameter can induce further weight loss in some patients whose loss has been inadequate. The 1.8% incidence of stoma ulceration may be lowered with the present emphasis on a smaller fundic pouch, but could increase with longer observation. Presently stoma ulcers occur once in every 140 patient years at risk.

The relationship of a variety of premorbid emotional and physical factors to the adjustment of burn patients during hospitalization is examined. Patients were considered to have adjusted poorly if they developed marked regression, severe depression, delirium or unmanageable behavior. Prior physical problems and premorbid psychopathology were found to be significantly more frequent among those who adjusted poorly than those who adjusted well, while greater severity of burn appeared to contribute to development of psychiatric complications less significantly. Further, the group who adjusted poorly tended to have a greater frequency of changes or stresses in their life situation prior to injury, suggesting that recent experience may also contribute to psychiatric morbidity during hospitalization.

The mortality rates associated with various surgical operations are compared in patients of the following four age groups: younger than 60, 60–69, 70–79, and 80 or older. The reasons for higher mortality in association with specific operations in aged patients are discussed.

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