No abstract

The National Bariatric Surgery Registry (NBSR) results reflect low perioperative risk for obesity surgery. Five deaths occurred within 40 d of operation in 5178 patients (0.1%). A subset of 3174 patients with complete information for complication and postoperative hospital stay was further studied. Females comprised 87% of the data set. Median values were determined for age, 37 y (18-70 y); operative weight, 121 kg (77-288 kg); and operative body mass index (BMI), 44 kg/m2 (29-91 kg/m2). Patients with no complications (89.7%) were reported to have a median postoperative stay of 4 d (2-23 d). The most severe complications were deep venous thrombosis (0.3%) and gastrointestinal leak (0.6%), with median postoperative hospital stay of 12 d (ranges 2-27 and 4-59 d, respectively). The most frequent complication reported was respiratory (4.5%), with median postoperative stay of 6 d (3-34 d). Median postoperative hospital stay for wound infection (1.6%) was 5 d.

Prophylactic cholecystectomy is left to the discretion of the surgeon when RYGBP is used. There has been an increase in cholecystectomy and malabsorptive operations during the last 15 years. When most of the small bowel is bypassed, all remaining gallbladders are removed. For patients with simple restriction operations, normal-appearing gallbladders are usually left in place. Urso-deoxycholic acid during rapid weight loss for prevention of gallstone formation is used in one-third of patients with remaining gallbladders.

These observations and their implications can be summarized in three statements which relate to action for improved patient care in the beginning of the new century: (1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread use of both 'simple' and 'complex' operations with increased modifications of standard RGB and VBG procedures emphasizes the need for standardized long-term data and analyses regarding both weight control and postoperative side-effects.

Simple and complex operations were equally effective in keeping patients alive in this cohort of patients operated on for severe obesity from 1986 to 1999. Young, female, non-smoking patients with low BMI at operation and no history of diabetes or hypertension had the longest survival. Longer follow-up for death is needed before any recommendations can be made for operation category based on survival.