These findings strongly support the use of aggressive surgical extirpation of all visible colorectal endometriosis for patients with advanced disease.

Twenty-six female patients were recalled for examination 10 years after a Roux-Y gastric bypass (RGB) procedure for morbid obesity, to determine whether there was biochemical and/or bone densitometry evidence of metabolic bone disease. These patients were compared with seven control patients who had achieved weight loss by dietary restriction. The serum calcium (4.3 +/- 0.03 vs 4.6 +/- 0.06 mEq/l; p = 0.002) was decreased in the RGB group. Both the serum alkaline phosphatase level (121.0 +/- 7.6 vs 87.3 +/- 8.3 U/I; p = 0.018) and the serum osteocalcin (12.6 +/- 1.2 vs 9.5 +/- 1.9 µg/ml; p = 0.078) level increased in the RGB group. The 1,25(OH) vitamin D level (50.5 +/- 2.5 vs 40.5 +/- 4.9 pg/ml; p = 0.152) was similar for both groups; the 25(OH) vitamin D level (24.3 +/- 1.6 vs 35.9 +/- 3.4 ng/ml; p = 0.008) was decreased in the RGB group as compared with the control group. Bone mineral density was elevated in three of the lumbar measurement sites, and marginally decreased (0.90 +/- 0.02 g/cm(2) vs 1.03 +/- 0.06 g/cm(2); p = 0.067) in the femoral neck of the RGB group compared with the controls. This biochemical pattern suggests the development of metabolic bone disease following the RGB.

Thirteen morbidly obese individuals were studied prospectively for 1 year after vertical banded gastroplasty (VBG) to determine the relationships between energy balance equation parameters and excess weight loss. The measured energy expenditure (MEE), as determined by indirect calorimetry, was not correlated with weight loss. However, when this parameter was expressed as a ratio to the predicted energy expenditure (PEE), the ratio was significantly correlated with the postoperative excess weight loss at 2, 6, and 12 months. The mean daily energy intake after the VBG was 2715 +/- 865 kJ. The postoperative energy intake was not correlated with the excess weight loss. Diet-induced thermogenesis was studied in eight patients. The mean diet-induced thermogenesis was 10.31% +/- 13.92%. The diet-induced thermogenesis was not correlated with the postoperative excess weight loss. The preliminary findings of this trial suggest that the MEE/PEE ratio is useful in predicting excess weight loss after VBG.

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