Bariatric Surgery in the New Millennium

Livingston, Edward H.

doi:10.1001/archsurg.142.10.919

Cited by 19 publications

(16 citation statements)

References 32 publications

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“…4,34 As Livingston has pointed out, there is a “great deal of overlap” between mental health disorders and obesity. 35 In addition to the potential increased risk for substance use disorders, there may exist post-surgical dissatisfaction related to pre-surgical expectations. Clearly, additional research related to the behavioral/psychological aspects before and following bariatric surgery, perhaps especially in the younger aged population, is warranted.…”

Section: Discussionmentioning

confidence: 99%

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality

et al. 2016

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Importance Bariatric surgery has been shown to be effective in reducing total and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known. Objectives To examine if gastric bypass surgery was equally effective in reducing mortality across different age-at-surgery groups. Design Total and cause-specific mortality rates and hazard ratios were estimated from a retrospective cohort within four categories defined by age at surgery: <35, 35–44, 45–54, and 55–74 years. Mean follow-up was 7.2 years. Setting Gastric bypass surgical patients seen at a private surgical practice from 1984 to 2002. Participants A cohort of 7925 gastric bypass surgery patients and 7925 group-matched, non-operated severely obese subjects identified through driver license records. Matching criteria included year of surgery to year of driver license application, gender, 5-year age groups and three BMI categories. Intervention Roux-en-Y gastric bypass surgery. Main Outcome Total and cause-specific mortality compared between those with and without gastric bypass surgery using hazard ratios. Results The mean age at surgery was 39.5±10.5 years and the mean pre-surgical BMI was 45.3±7.4 kg. Compared with non-operated subjects, adjusted all-cause mortality after gastric bypass surgery was significantly lower for the 35–44, 45–54, and 55–74 year age groups (hazard ratios (HR) of 0.54 (95% confidence interval of 0.38–0.77), 0.43 (0.30–0.62), and 0.50 (0.31–0.70), respectively; all p<0.005) but was not lower for the <35 year age group (HR 1.22 (0.82–1.81)). The lack of mortality benefit in the <35 age group primarily derived from a significantly higher number of externally-caused deaths (HR 2.53 (1.27–5.07)). Gastric bypass patients had a significantly lower age-related increase in mortality than non-operated severely obese subjects (p=0.0014). Conclusions Gastric bypass surgery was associated with improved long-term survival for all ages-at-surgery >35 years, with externally-caused deaths only elevated in younger women. Gastric bypass surgery is protective against mortality even for older patients and also reduces the age-related increase in mortality observed in severely obese non-surgical subjects.

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Section: Discussionmentioning

confidence: 99%

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality

et al. 2016

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“…These operations are prescribed to treat morbid obesity, type 2 diabetes, hypertension, sleep apnea, and other comorbid conditions. Bariatric surgery is the most effective current treatment for morbid obesity in order to produce significant and sustained weight loss as well as markedly reduced comorbidities [2]. There are two main principles of bariatric surgery which exist either in combination or alone: restriction and malabsorption.…”

Section: Bariatric Surgerymentioning

confidence: 99%

“…In the United States, more than one-third of the population is overweight, and approximately 15 million people (about 5%) are considered morbidly obese (defined as a body mass index greater than 40) [1]. Bariatric surgery has proven to be the most effective treatment for morbid obesity [2]. In 2008, about 220,000 bariatric and metabolic operations were performed in the United States.…”

Section: Introductionmentioning

confidence: 99%

“…In 2008, about 220,000 bariatric and metabolic operations were performed in the United States. Despite a major evolution in bariatric surgery over the past two decades, the Roux-en-Y gastric bypass procedure (RYGB) remains the most effective bariatric operation in the United States [2]. This popular procedure entails the long-term complications of hematological disorders, especially chronic anemia [3].…”

Section: Introductionmentioning

confidence: 99%

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Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

Chen

Krishnamurthy

Mohamed

et al. 2013

BioMed Research International

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Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

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“…Fear of complications remains the most widely cited objection to bariatric surgery referrals among referring doctors, and it remains the most widely cited objection to bariatric surgery among patients who most need it [39]. If we are to bring this life-saving intervention to more individuals, then we must relentlessly reduce complications, the most serious of which is leak in sleeve gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

Warner

Sasse

2017

Minimally Invasive Surgery

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Introduction Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1–3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure.

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Bariatric Surgery in the New Millennium

Cited by 19 publications

References 32 publications

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality

Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality

Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

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