A Decade of Change in Obesity Surgery

Mason, Edward E.; Tang, Shenghui; Renquist, Kathleen E; Barnes, Dwight; Cullen, Joseph J.; Doherty, Cornelius; Maher, James W.; Contributors, National Bariatric Surgery Registry

doi:10.1381/096089297765555719

Cited by 131 publications

(32 citation statements)

References 5 publications

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“…6,7 Although cardiopulmonary complications after open RYGBP are rare, they are an important contributor to major complications and death. 30 Further, patients with obesity-related respiratory dysfunction have a fivefold increase in perioperative death after open RYGBP. 30 Because of the relatively low frequency and inconsistent reporting, direct comparison of rates of cardiopulmonary complications between this series and open series is not feasible.…”

Section: Discussionmentioning

confidence: 99%

“…30 Further, patients with obesity-related respiratory dysfunction have a fivefold increase in perioperative death after open RYGBP. 30 Because of the relatively low frequency and inconsistent reporting, direct comparison of rates of cardiopulmonary complications between this series and open series is not feasible. Thus, we can make no significant conclusions regarding decreased rates of cardiopulmonary complications with the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

et al. 2000

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ObjectiveTo evaluate the short-term outcomes for laparoscopic Rouxen-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months. Summary Background DataThe Roux-en-Y gastric bypass is a highly successful approach to morbid obesity but results in significant perioperative complications. A laparoscopic approach has significant potential to reduce perioperative complications and recovery time. MethodsConsecutive patients (n ϭ 275) who met NIH criteria for bariatric surgery were offered laparoscopic Roux-en-Y gastric bypass between July 1997 and March 2000. A 15-mL gastric pouch and a 75-cm Roux limb (150 cm for superobese) was created using five or six trocar incisions. ResultsThe conversion rate to open gastric bypass was 1%. The start of an oral diet began a mean of 1.58 days after surgery, with a median hospital stay of 2 days and return to work at 21 days. The incidence of early major and minor complications was 3.3% and 27%, respectively. One death occurred related to a pulmonary embolus (0.4%). The hernia rate was 0.7%, and wound infections requiring outpatient drainage only were uncommon (5%). Excess weight loss at 24 and 30 months was 83% and 77%, respectively. In patients with more than 1 year of follow-up, most of the comorbidities were improved or resolved, and 95% reported significant improvement in quality of life. ConclusionLaparoscopic Roux-en-Y gastric bypass is effective in achieving weight loss and in improving comorbidities and quality of life while reducing recovery time and perioperative complications.Roux-en-Y gastric bypass (RYGBP) has been shown to produce significant weight loss in patients with clinically severe obesity: most studies report a weight loss of 60% to 70% of excess body weight.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

et al. 2000

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“…Thus, the distance between the mouth and gastric remnant was 80-100 cm, allowing retro- grade visualization and study of the bypassed area with a flexible endoscope. [1][2][3][4][10][11][12] As an increasing number of patients underwent the RYGBP, it became clear that even if they were losing considerable weight, overall results could be improved with somewhat longer limbs. Moreover as more patients with high BMI underwent RYGBP, some authors decided to tailor the limb's length with the BMI, so patients with BMIs >50 had longer limbs than those with BMIs <50.…”

Section: Discussionmentioning

confidence: 99%

“…2 The Roux-en-Y gastric bypass, either performed through an open (RYGBP) or laparoscopic approach (LRYGBP), has become the procedure of choice for morbid obesity in the USA. 3 Most studies report a weight loss of 60% to 70% of excess body weight, with long-term weight loss extending to 10 years and longer. 1,4 In creating a tiny gastric pouch, a major portion of the stomach is bypassed.…”

Section: Introductionmentioning

confidence: 99%

Histologic Studies of the Bypassed Stomach after Roux-en-Y Gastric Bypass in a Porcine Model

Gentileschi

Gautier²,

Milone³

et al. 2006

obes surg

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Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is highly effective for morbid obesity. However, the long-term effects in the bypassed segments are unknown. The aim of this study is to evaluate gastrin and histologic changes in bypassed segments after LRYGBP.Methods: 10 50-kg pigs were subjected to LRYGBP. Preoperative weight and serum gastrin were compared with similar measures at 6 months postoperatively, when the pigs were euthanized. At necropsy, full-thickness gastric, duodenal, and jejunal biopsies were performed. Normal biopsies were obtained from a control group of 10 pigs.Results: 1 pig died at 3 months postoperatively because of an intestinal intussusception. In the remaining 9 pigs, weight increased after surgery from 52±2.2 kg to 55±1.9 kg. Serum gastrin was unchanged after surgery (mean 68.2 vs 68.3 pg/mL at 3 months and 61.7 pg/mL at 6 months). Histology showed no abnormalities from sections in all control pigs, and in 7 of the LRYGBP pigs as well. 1 LRYGBP pig was found to have hyperplastic duodenal glands, jejunal mucosa with mild chronic inflammation, and gastric mucosa with focal erosive gastritis. 1 LRYGBP pig had jejunal sections showing Peyer's patches.Conclusion: LRYGBP is not associated with gastrin changes and major histologic changes in the bypassed segments, at 6 months postoperatively in the porcine model.

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“…This surgical technique is classified among those defined as 'restrictive' because it aims to significantly reduce the stomach volume and thus induce a feeling of early satiety. 8,9 The aim of our study was to assess alterations of the AI and EI parameters in obese patients who lost weight after the application of adjustable gastric banding and a program of lifestyle changes including Mediterranean diet and daily moderate exercise, and correlate them with some biochemical blood parameters (glucose, insulin, lipid levels).…”

Section: Introductionmentioning

confidence: 99%

The effects of weight loss due to gastric banding and lifestyle modification on red blood cell aggregation and deformability in severe obese subjects

et al. 2011

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Objective: To investigate the changes in the aggregation index (AI) and the elongation index (EI), in severe obese subjects (MbObS) undergoing laparoscopic adjustable gastric banding (LAGB). AI and EI are measured by Laser assisted Optical Rotational Red Cell Analyzer (LORCA) and are markers of erythrocyte aggregation and deformability, respectively. Design and subjects: Before, 3 and 6 months after LAGB plus lifestyle changes (Mediterranean diet plus daily moderate exercise), we evaluated AI, EI, body mass index (BMI), total (ToT) cholesterol (Chol), high-density lipoprotein (HDL)-Chol, lowdensity lipoprotein (LDL)-Chol, triglycerides and fasting glucose and insulin levels in 20 MbObS. The Student's t-test was used for comparisons between independent groups and the analysis of variance to assess differences in AI and EI at the 3 time points. Pearson's correlation coefficient was used to assess correlation among continuous variables and multiple linear regression analysis to assess predictive factors for AI and EI changes. Results: BMI and all blood parameters showed a statistically significant decline 3 and 6 months after LAGB as compared with basal, except for EI and HDL-Chol that significantly increased. Stepwise selection of predictors shows that at 3 and 6 months, EI values depended on HDL-Chol values at the same time point. In the EI model, blood glucose was also statistically significant at 6 months. Conclusion: Our data show a significant improvement in EI after LAGB-induced weight loss, which correlates with an improved lipid pattern and support the idea that the rapid weight loss induced by LAGB plus lifestyle changes might reduce the thromboembolic risk and the high mortality risk found in MbObS.

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A Decade of Change in Obesity Surgery

Cited by 131 publications

References 5 publications

Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Histologic Studies of the Bypassed Stomach after Roux-en-Y Gastric Bypass in a Porcine Model

The effects of weight loss due to gastric banding and lifestyle modification on red blood cell aggregation and deformability in severe obese subjects

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