title: Cost-Efficacy of Surgically Induced Weight Loss for the Management of Type 2 Diabetes Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Gastrointestinal function and eating behavior after gastric bypass and duodenal switch. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Randomized Double-Blinded Trial of Laparoscopic Gastric Imbrication v Laparoscopic Sleeve Gastrectomy at a Single Indian Institution Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Laparoscopic adjustable gastric banding with truncal vagotomy versus laparoscopic adjustable gastric banding alone: interim results of a prospective randomized trial. Weight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Randomized Clinical Trial of Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for the Management of Patients with BMI < 50 kg/m2 Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial The By-Band study: gastric bypass or adjustable gastric band surgery to treat morbid obesity: study protocol for a multi-centre randomised controlled trial with an internal pilot phase Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Prospective, Double Blind Study Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding or an Intensive Medical Program Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. A controlled clinical trial of the effect of gastric bypass surgery and intensive lifestyle intervention on nocturnal hypertension and the circadian blood pressure rhythm in patients with morbid obesity. Beta cell function after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Weight loss maintenance in successful weight losers: surgical versus non-surgical methods Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity Early Results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS) Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity: A Prospective Randomized Controlled Clinical Trial Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. A Prospective Randomized Study Between Laparoscopic Gastric Banding and Laparoscopic Isolated Sleeve Gastrectomy: Results after 1 and 3 Years A Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding for the Treatment of Morbid Obesity: Outcomes, Quality of Life, and Costs Changes in body composition with weight loss: obese subjects randomized to surgical and medical programs. A Multicenter, Randomized Efficacy Study of the EndoBarrier Gastrointestinal Liner for Presurgical Weight Loss Prior to Bariatric Surgery Laparoscopic gastric plication versus mini-gastric bypass surgery in the treatment of morbid obesity: a randomized clinical trial. Laparoscopic sleeve gastrectomy for obesity. Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass--a randomized controlled trial. Long-Term Results of a Prospective Comparison of Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population (BMI 35–50 kg/m2) Myocardial oxygen consumption change predicts left ventricular relaxation improvement in obese humans after weight loss. Does Surgically Induced Weight Loss Improve Daytime Sleepiness? Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding. Gastroesophageal reflux disease and esophageal motility in morbidly obese patients submitted to laparoscopic adjustable silicone gastric banding or laparoscopic vertical banded gastroplasty Clinical Improvement After Duodenojejunal Bypass for Nonobese Type 2 Diabetes Despite Minimal Improvement in Glycemic Homeostasis Fewer Nutrient Deficiencies After Laparoscopic Sleeve Gastrectomy (LSG) than After Laparoscopic Roux-Y-Gastric Bypass (LRYGB)—a Prospective Study Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. Long‐term results of a randomized clinical trial comparing Roux‐en‐$\hbox{Y}$ gastric bypass with vertical banded gastroplasty Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity Maximal weight loss after banded and unbanded laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Bariatric surgery versus conventional medical therapy for type 2 diabetes. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Is Laparoscopic Duodenojejunal Bypass with Sleeve an Effective Alternative to Roux En Y Gastric Bypass in Morbidly Obese Patients: Preliminary Results of a Randomized Trial
abstract: OBJECTIVE To determine the within-trial cost-efficacy of surgical therapy relative to conventional therapy for achieving remission of recently diagnosed type 2 diabetes in class I and II obese patients . RESEARCH DESIGN AND METHODS Efficacy results were derived from a 2-year r and omized controlled trial . A health sector perspective was adopted , and within-trial intervention costs included gastric b and ing surgery , mitigation of complications , outpatient medical consultations , medical investigations , pathology , weight loss therapies , and medication . Re source use was measured based on data drawn from a trial data base and patient medical records and valued based on private hospital costs and government schedules in 2006 Australian dollars ( AUD ) . An incremental cost-effectiveness analysis was undertaken . RESULTS Mean 2-year intervention costs per patient were 13,400 AUD for surgical therapy and 3,400 AUD for conventional therapy , with laparoscopic adjustable gastric b and ( LAGB ) surgery accounting for 85 % of the difference . Outpatient medical consultation costs were three times higher for surgical patients , whereas medication costs were 1.5 times higher for conventional patients . The cost differences were primarily in the first 6 months of the trial . Relative to conventional therapy , the incremental cost-effectiveness ratio for surgical therapy was 16,600 AUD per case of diabetes remitted ( currency exchange : 1 AUD = 0.74 USD ) . CONCLUSIONS Surgical therapy appears to be a cost-effective option for managing type 2 diabetes in class I and II obese patients Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative BACKGROUND Duodenal switch provides greater weight loss than gastric bypass in severely obese patients ; however , comparative data on the changes in gastrointestinal symptoms , bowel function , eating behavior , dietary intake , and psychosocial functioning are limited . METHODS The setting for the present study was 2 university hospitals in Norway and Sweden . Participants with a body mass index of 50 - 60 kg/m(2 ) were r and omly assigned to gastric bypass  ( n = 31 ) or  duodenal switch  ( n = 29 ) and followed up for 2 years . Of the 60 patients , 97 % completed the study . Their mean weight decreased by 31.2 % after gastric bypass and 44.8 % after duodenal switch . At inclusion and 1 and 2 years of follow-up , the participants completed the Gastrointestinal Symptom Rating Scale , a bowel function question naire , the Three-Factor Eating Question naire-R21 , a 4-day food record , and the Obesity-related Problems scale . RESULTS Compared with the gastric bypass group , the duodenal switch group reported more symptoms of diarrhea ( P = .0002 ) , a greater mean number of daytime defecations ( P = .007 ) , and more anal leakage of stool ( 50 % versus 18 % of participants , respectively ; P = .015 ) after 2 years . The scores for uncontrolled and emotional eating were significantly and similarly reduced after both operations . The mean total caloric intake and intake of fat and carbohydrates were significantly reduced in both groups . Protein intake was significantly reduced only after gastric bypass ( P = .008 , between-group comparison ) . Psychosocial function was significantly improved after both operations ( P = .23 , between the 2 groups ) . CONCLUSION Gastrointestinal side effects and anal leakage of stool were more pronounced after duodenal switch than after gastric bypass . Both procedures led to reduced uncontrolled and emotional eating , reduced caloric intake , and improved psychosocial functioning BACKGROUND There are few studies of long-term outcomes for either laparoscopic adjustable gastric b and ing ( LAGB ) or laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . The objective of this study was to compare outcomes of patients r and omly assigned to undergo LAGB or LRYGB  at 10 years . METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 ± 8.9 years ; range 20 - 49 ) were r and omly allocated to undergo either LAGB  ( n = 27 , 5 men and 22 women ; mean age 33.3 years ; mean weight 120 kg ; mean body mass index [ BMI ] 43.4 kg/m(2 ) ) or LRYGB ( n = 24 , 4 men and 20 women ; mean age 34.7 ; mean weight 120 kg ; mean BMI 43.8 kg/m(2 ) ) . Data on complications , reoperations , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . The data were analyzed using Student 's t test and Fisher 's exact test , with P<.05 considered significant . RESULTS Five patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients . Reoperations were required in 9 ( 40.9 % ) of 22 LAGB patients and in 6 ( 28.6 % ) of the 21 LRYGB patients . At 10-year follow-up , the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients ( 69±29 % versus 46±27 % ; P = .03 ) . CONCLUSION LRYGB was superior to LAGB in term of excess weight loss results ( 76.2 % versus 46.2 % ) at 10 years . However , LRYGB exposes patients to higher early complication rates than LAGB ( 8.3 % versus 0 % ) and potentially lethal long-term surgical complications ( internal hernia and bowel obstruction rate : 4.7 % ) Background Currently , there is a debate whether the laparoscopic gastric imbrication ( LGI ) offers similar weight loss when compared to the laparoscopic sleeve gastrectomy ( LSG ) . On the surface , they seem to offer similar-sized stomachs after the procedures are performed . We chose to perform a r and omized double-blinded trial to see if similar-sized pouches result in similar types of weight loss . Our belief was that sleeve gastrectomy would offer at least a 10 % better weight loss over a 3-year period . Methods Thirty patients were r and omized to one of two arms . The patients and the third party administrator following the patients were blinded as to which procedure was chosen . The surgeon had full knowledge of the patients ’ surgery throughout the treatment . The decision of which arm to place them was made by a single employee of the third party administrator and not shared with the employees following the patients . Patients were then followed for 3 years . Results There were no differences in weight , age , or BMI preoperatively . There were no differences between the two groups at any follow-up time point from 6 months to 3 years . Follow-up was 100 % . Conclusion Due to the large st and ard deviations present in both groups , there was no statistical difference between either of the groups in terms of weight loss CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 CONTEXT Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes . OBJECTIVE To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control . DESIGN , SETTING , AND PARTICIPANTS Unblinded r and omized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia , with general community recruitment to established treatment programs . Participants were 60 obese patients ( BMI > 30 and < 40 ) with recently diagnosed ( < 2 years ) type 2 diabetes . INTERVENTIONS Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric b and ing with conventional diabetes care . MAIN OUTCOME MEASURES Remission of type 2 diabetes ( fasting glucose level < 126 mg/dL [ 7.0 mmol/L ] and glycated hemoglobin [ HbA1c ] value < 6.2 % while taking no glycemic therapy ) . Secondary measures included weight and components of the metabolic syndrome . Analysis was by intention-to-treat . RESULTS Of the 60 patients enrolled , 55 ( 92 % ) completed the 2-year follow-up . Remission of type 2 diabetes was achieved by 22 ( 73 % ) in the surgical group and 4 ( 13 % ) in the conventional-therapy group . Relative risk of remission for the surgical group was 5.5 ( 95 % confidence interval , 2.2 - 14.0 ) . Surgical and conventional-therapy groups lost a mean ( SD ) of 20.7 % ( 8.6 % ) and 1.7 % ( 5.2 % ) of weight , respectively , at 2 years ( P < .001 ) . Remission of type 2 diabetes was related to weight loss ( R2 = 0.46 , P < .001 ) and lower baseline HbA1c levels ( combined R2 = 0.52 , P < .001 ) . There were no serious complications in either group . CONCLUSIONS Participants r and omized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss . These results need to be confirmed in a larger , more diverse population and have long-term efficacy assessed . TRIAL REGISTRATION actr.org Identifier : ACTRN012605000159651 IMPORTANCE Controlling glycemia , blood pressure , and cholesterol is important for patients with diabetes . How best to achieve this goal is unknown . OBJECTIVE To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 2-group unblinded r and omized trial at 4 teaching hospitals in the United States and Taiwan involving 120 participants who had a hemoglobin A1c ( HbA1c ) level of 8.0 % or higher , body mass index ( BMI ) between 30.0 and 39.9 , C peptide level of more than 1.0 ng/mL , and type 2 diabetes for at least 6 months . The study began in April 2008 . INTERVENTIONS Lifestyle-intensive medical management intervention and Roux-en-Y gastric bypass surgery . Medications for hyperglycemia , hypertension , and dyslipidemia were prescribed according to protocol and surgical techniques that were st and ardized . MAIN OUTCOMES AND MEASURES Composite goal of HbA1c less than 7.0 % , low-density lipoprotein cholesterol less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg . RESULTS All 120 patients received the intensive lifestyle-medical management protocol and 60 were r and omly assigned to undergo Roux-en-Y gastric bypass . After 12-months , 28 participants ( 49 % ; 95 % CI , 36%-63 % ) in the gastric bypass group and 11 ( 19 % ; 95 % CI , 10%-32 % ) in the lifestyle-medical management group achieved the primary end points ( odds ratio [ OR ] , 4.8 ; 95 % CI , 1.9 - 11.7 ) . Participants in the gastric bypass group required 3.0 fewer medications ( mean , 1.7 vs 4.8 ; 95 % CI for the difference , 2.3 - 3.6 ) and lost 26.1 % vs 7.9 % of their initial body weigh compared with the lifestyle-medical management group ( difference , 17.5 % ; 95 % CI , 14.2%-20.7 % ) . Regression analyses indicated that achieving the composite end point was primarily attributable to weight loss . There were 22 serious adverse events in the gastric bypass group , including 1 cardiovascular event , and 15 in the lifestyle-medical management group . There were 4 perioperative complications and 6 late postoperative complications . The gastric bypass group experienced more nutritional deficiency than the lifestyle-medical management group . CONCLUSIONS AND RELEVANCE In mild to moderately obese patients with type 2 diabetes , adding gastric bypass surgery to lifestyle and medical management was associated with a greater likelihood of achieving the composite goal . Potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies of diabetes must be weighed against the risk of serious adverse events . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00641251 BACKGROUND Few weight loss surgery trials have evaluated the changes in health-related quality of life ( HRQOL ) relative to obese individuals not participating in weight loss interventions . In a prospect i ve study at a bariatric surgery practice , we evaluated the 2-year changes in HRQOL in gastric bypass patients compared with 2 severely obese groups who did not undergo surgical weight loss .  METHODS A total of 308 gastric bypass patients were compared with 253 individuals who sought but did not undergo gastric bypass and 272 population -based obese individuals using the weight-related ( Impact of Weight on Quality of Life-Lite ) and general ( Medical Outcomes Study 36-item Short-Form Health Survey ) HRQOL question naires at baseline and 2 years of follow-up . RESULTS The percentage of weight loss was 34.2 % for the gastric bypass and 1.4 % for the no gastric bypass groups , with a .5 % gain for population -based obese group . Both measures of HRQOL showed greater improvements for the gastric bypass group , even after controlling for baseline differences . Effect sizes for changes in physical and weight-related HRQOL were very large for gastric bypass , but small to medium for the 2 comparison groups . Effect sizes for changes in the psychosocial aspects of HRQOL were moderate to very large for gastric bypass , but small for the 2 comparison groups . Of the gastric bypass patients , 97 % had meaningful improvements in the Impact of Weight on Quality of Life-Lite total score compared with 43 % of the no gastric bypass group and 30 % of the population -based obese group . CONCLUSION Dramatic improvements had occurred in weight-related and physical HRQOL for gastric bypass patients at 2 years after surgery compared with 2 severely obese groups who had not undergone surgery . These results support the effectiveness of gastric bypass surgery in improving patients ' HRQOL BACKGROUND To perform a prospect i ve , r and omized comparison of laparoscopic adjustable gastric b and ing ( LAGB ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) .  METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 + /- 8.9 years , range 20 - 49 ) were r and omly allocated to undergo either LAGB ( n = 27 , 5 men and 22 women , mean age 33.3 years , mean weight 120 kg , mean body mass index [ BMI ] 43.4 kg/m(2 ) ; percentage of excess weight loss 83.8 % ) or LRYGB ( n = 24 , 4 men and 20 women , mean age 34.7 , mean weight 120 kg , mean BMI 43.8 kg/m(2 ) , percentage of excess weight loss 83.3 ) . Data on the operative time , complications , reoperations with hospital stay , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . Failure was considered a BMI of > 35 at 5 years postoperatively . The data were analyzed using Student 's t test and Fisher 's exact test , with P < .05 considered significant . RESULTS The mean operative time was 60 + /- 20 minutes for the LAGB group and 220 + /- 100 minutes for the LRYGB group ( P < .001 ) . One patient in the LAGB group was lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients because of a posterior leak of the gastrojejunal anastomosis . Reoperations were required in 4 ( 15.2 % ) of 26 LAGB patients , 2 because of gastric pouch dilation and 2 because of unsatisfactory weight loss . One of these patients required conversion to biliopancreatic diversion ; the remaining 3 patients were on the waiting list for LRYGB . Reoperations were required in 3 ( 12.5 % ) of the 24 LRYGB patients , and each was because of a potentially lethal complication . No LAGB patient required reoperation because of an early complication . Of the 27 LAGB patients , 3 had hypertension and 1 had sleep apnea . Of the 24 LRYGB patients , 2 had hyperlipemia , 1 had hypertension , and 1 had type 2 diabetes . Five years after surgery , the diabetes , sleep apnea , and hyperlipemia had resolved . At the 5-year ( range 60 - 66 months ) follow-up visit , the  LRYGB  patients had significantly lower weight and BMI and a greater percentage of excess weight loss than did the LAGB patients . Weight loss failure ( BMI > 35 kg/m(2 ) at 5 yr ) was observed in 9 ( 34.6 % ) of 26 LAGB patients and in 1 ( 4.2 % ) of 24 LRYGB patients ( P < .001 ) . Of the 26 patients in the LAGB group and 24 in the LRYGB group , 3 ( 11.5 % ) and 15 ( 62.5 % ) had a BMI of < 30 kg/m(2 ) , respectively ( P < .001 ) . CONCLUSION The results of our study have shown that LRYGB results in better weight loss and a reduced number of failures compared with LAGB , despite the significantly longer operative time and life-threatening complications BACKGROUND In an attempt to potentiate the effect of laparoscopic gastric b and ing ( LGB ) on weight reduction and to reduce the risk of weight regain , we added laparoscopic truncal vagotomy ( TV ) to adjustable LGB . We report on our early interim results of a prospect i ve 5-year r and omized clinical trial comparing patients who underwent LGB plus TV ( LGBTV ) with a control group who underwent LGB alone .  METHODS From December 2005 to November 2006 , patients were r and omly allocated to LGBTV or LGB alone .  In the LGBTV group , the anterior and posterior vagus trunks were isolated and resected after preparing and encircling the esophagus at the diaphragmatic crus . In both groups , an 11-cm Lap-B and System was positioned by way of the pars flaccida . RESULTS A total of 50 patients were entered into the study . No mortality result ed , and no conversion to laparotomy was needed . Neither group had any intra- or postoperative complications . The mean weight , body mass index , and percentage of excess weight loss were not significantly different statistically between the 2 groups at 12 or 18 months after surgery ( P = NS ) . At 6 months of follow-up , b and adjustment was not required in 10 ( 50 % ) of 20 patients with LGBTV compared with 5 ( 20 % ) of 25 patients with LGB alone ( P = .034 ) . At 12 months , 7 ( 35 % ) of 20 LGBTV patients and 2 ( 8 % ) of 25 LGB patients still did not require b and adjustment ( P = .024 ) . CONCLUSION The results of our study have shown that adding TV to LGB does not cause specific morbidity or mortality compared with LGB alone . During the first postoperative year , the addition of TV to LGB decreased the number of patients requiring b and adjustments BACKGROUND Gastric bypass and duodenal switch are currently performed bariatric surgical procedures . Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass . OBJECTIVE To determine whether duodenal switch leads to greater weight loss and more favorable improvements in cardiovascular risk factors and quality of life than gastric bypass . DESIGN R and omized , parallel-group trial . ( Clinical Trials.gov registration number : NCT00327912 ) SETTING 2 academic medical centers ( 1 in Norway and 1 in Sweden ) . PATIENTS 60 participants with a body mass index ( BMI ) between 50 and 60 kg/m(2 ) . INTERVENTION Gastric bypass ( n = 31 ) or duodenal switch ( n = 29 ) . MEASUREMENTS The primary outcome was the change in BMI after 2 years . Secondary outcomes included anthropometric measures ; concentrations of blood lipids , glucose , insulin , C-reactive protein , and vitamins ; and health-related quality of life and adverse events . RESULTS Fifty-eight of 60 participants ( 97 % ) completed the study . The mean reductions in BMI were 17.3 kg/m(2 ) ( 95 % CI , 15.7 to 19.0 kg/m(2 ) ) after gastric bypass and 24.8 kg/m(2 ) ( CI , 23.0 to 26.5 kg/m(2 ) ) after duodenal switch ( mean between-group difference , 7.44 kg/m(2 ) [ CI , 5.24 to 9.64 kg/m(2 ) ] ; P < 0.001 ) . Total cholesterol concentration decreased by 0.24 mmol/L ( CI , -0.03 to 0.50 mmol/L ) ( 9.27 mg/dL [ CI , -1.16 to 19.3 mg/dL ] ) after gastric bypass and 1.07 mmol/L ( CI , 0.79 to 1.35 mmol/L ) ( 41.3 mg/dL [ CI , 30.5 to 52.1 mg/dL ] ) after duodenal switch ( mean between-group difference , 0.83 mmol/L [ CI , 0.48 to 1.18 mmol/L ] ; 32.0 mg/dL [ CI , 18.5 to 45.6 mg/dL ] ; P ≤ 0.001 ) . Reductions in low-density lipoprotein cholesterol concentration , anthropometric measures , fat mass , and fat-free mass were also greater after duodenal switch ( P ≤ 0.010 for each between-group comparison ) . Both groups had reductions in blood pressure and mean concentrations of glucose , insulin , and C-reactive protein , with no between-group differences . The duodenal switch group , but not the gastric bypass group , had reductions in concentrations of vitamin A and 25-hydroxyvitamin D. Most Short Form-36 Health Survey dimensional scores improved in both groups , with greater improvement in 1 of 8 domains ( bodily pain ) after gastric bypass . From surgery until 2 years , 10 participants ( 32 % ) had adverse events after gastric bypass and 18 ( 62 % ) after duodenal switch ( P = 0.021 ) . Adverse events related to malnutrition occurred only after duodenal switch . LIMITATION Clinical experience was greater with  gastric  bypass than with duodenal switch at the study centers . CONCLUSION Duodenal switch surgery was associated with greater weight loss , greater reductions of total and low-density lipoprotein cholesterol concentrations , and more adverse events . Improvements in other cardiovascular risk factors and quality of life were similar after both procedures . PRIMARY FUNDING SOURCE South-Eastern Norway Regional Health Authority Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) is currently the gold st and ard bariatric procedure for the treatment of morbid obesity . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively innovative procedure which has been increasingly applied lately as a sole bariatric procedure . A r and omized trial was conducted in a Greek population to evaluate perioperative safety and 3-years results . Methods Sixty patients with body mass index ( BMI ) ≤ 50 Kg/m2 were r and omized to LRYGB or LSG .  Patients were monitored for 3 years postoperatively and throughout the study period weight loss , in terms of percent excess weight loss ( % EWL ) , early and late complications , improvement of obesity related comorbidities and nutritional deficiencies were compared between groups . Results There was no death in either group and there was no significant difference in early ( 10 % after LRYGB and 13 % after LSG , P > 0.05 ) and late morbidity ( 10 % in each group ) . Weight loss was significantly better after LSG in the first years of the study and at 3 years % EWL reached 62 % after LRYGB and 68 % after LSG ( p = 0.13 ) . There was no significant difference in the overall improvement of comorbidities . Nutritional deficiencies occurred at the same rate in the two groups except to vitamin B12 deficiency which was more common after LRYGB ( P = 0.05 ) . Conclusion LSG and LRYGB are equally safe and effective in the amelioration of comorbidities , while LSG is associated with fewer postoperative metabolic deficiencies , without the need of supplementation . Furthermore , LSG is a promising bariatric procedure , equally effective to LRYGB at 3 years follow up on weight reduction Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson Background The prevalence of severe and complex obesity is increasing worldwide and surgery may offer an effective and lasting treatment . Laparoscopic adjustable gastric b and and Roux-en-Y gastric bypass surgery are the two main surgical procedures performed . Design This open parallel-group r and omised controlled trial will compare the effectiveness , cost-effectiveness and acceptability of gastric b and ( B and ) versus gastric bypass ( Bypass ) in adults with severe and complex obesity . It has an internal pilot phase ( in two centres ) with integrated qualitative research to establish effective and optimal methods for recruitment . Adults with a body mass index ( BMI ) of 40 kg/m2 or more , or a BMI of 35 kg/m2 or more and other co-morbidities will be recruited . At the end of the internal pilot the study will exp and into more centres if the pre-set progression criteria of numbers and rates of eligible patients screened and r and omised are met and if the expected rates of retention and adherence to treatment allocation are achieved . The trial will test the joint hypotheses that Bypass is non-inferior to B and with respect to more than 50 % excess weight loss and that Bypass is superior to B and with respect to health related quality of life ( HRQOL , EQ-5D ) at three years . Secondary outcomes include other weight loss measures , waist circumference and remission/resolution of co-morbidities ; generic and symptom-specific HRQOL ; nutritional blood test results ; re source use ; eating behaviours and adverse events . A core outcome set for reporting the results of obesity surgery will be developed and a systematic review of the evidence for sleeve gastrectomy undertaken to inform the main study design . Discussion By-B and is the first pragmatic study to compare the two most commonly performed bariatric surgical procedures for severe and complex obesity . The design will enable and empower surgeons to learn to recruit and participate in a r and omised study . Early evidence shows that timely recruitment is possible . Trial registration Current Controlled Trials IS RCT N00786323 Background : Bariatric surgery is currently the most effective treatment in morbidly obese patients , leading to durable weight loss . Objective : In this prospect i ve double blind study , we aim to evaluate and compare the effects of  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) with laparoscopic sleeve gastrectomy ( LSG )  on body weight , appetite , fasting , and postpr and ial ghrelin and peptide-YY ( PYY ) levels . Methods : After r and omization , 16 patients were assigned to LRYGBP and 16 patients to LSG .  Patients were reevaluated on the 1st , 3rd , 6th , and 12th postoperative month . Blood sample s were collected after an overnight fast and in 6 patients in each group after a st and ard 420 kcal mixed meal . Results : Body weight and body mass index ( BMI ) decreased markedly ( P < 0.0001 ) and comparably after either procedure . Excess weight loss was greater after LSG at 6 months ( 55.5 % ± 7.6 % vs. 50.2 % ± 6.5 % , P = 0.04 ) and 12 months ( 69.7 % ± 14.6 % vs. 60.5 % ± 10.7 % , [ P = 0.05 ] ) . After LRYGBP fasting ghrelin levels did not change significantly compared with baseline ( P = 0.19 ) and did not decrease significantly after the test meal . On the other h and , LSG was followed by a marked reduction in fasting ghrelin levels ( P < 0.0001 ) and a significant suppression after the meal . Fasting PYY levels increased after either surgical procedure ( P ≤ 0.001 ) . Appetite decreased in both groups but to a greater extend after LSG . Conclusion : PYY levels increased similarly after either procedure . The markedly reduced ghrelin levels in addition to increased PYY levels after LSG , are associated with greater appetite suppression and excess weight loss compared with LRYGBP Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a body mass index of 30 kg/m2 to 35 kg/m2 ; had identifiable problems , including an obesity-related comorbid condition ( such as hypertension , dyslipidemia , diabetes , obstructive sleep apnea , or gastroesophageal reflux disease ) , severe physical limitations , or clinical ly significant psychosocial problems associated with their obesity ; had attempted to reduce weight over at least the previous 5 years ; could underst and the options offered and the r and omization process ; and were willing to comply with the requirements of each program . Exclusion Criteria We excluded c and i date s with a history of bariatric surgery or medical problems that contraindicated treatment in either study group , such as impaired mental status , drug or alcohol addiction , or portal hypertension . In addition , we excluded participants if they had undergone an intensive , physician-supervised program that used very-low-calorie diets or pharmacotherapy or if they did not attend the 2 initial patient information visits . Assessment We provided detailed information about the problems of obesity and about the 2 study groups through at least 2 discussion periods and a patient information booklet . Initial assessment included anthropometric measures ; identification of medical , physical , or psychosocial problems ( both weight-related and other ) ; and a discussion of previous weight loss efforts . The assessment included a detailed dietary history by the trial dietitian and a review by a specialist physician to determine the presence and severity of associated medical conditions . Initial investigations included measurements of fasting blood glucose level ; serum insulin level ; and a lipid profile , including HDL cholesterol and LDL cholesterol levels . After initial assessment , we instituted a program of advice on appropriate eating patterns and exercise and followed each patient on a monthly basis for 3 months . During this time , we assessed the patients ' fulfillment of tasks , such as completion of a food diary , and overall adherence to appointments . R and omization Process We r and omly allocated eligible patients to receive a conventional , intensive , nonsurgical program or laparoscopic adjustable gastric b and ing .  A computer-derived r and om allocation sequence , without blocking or stratification , performed the r and omization . This was prepared at the trial office . The trial coordinator enrolled participants and informed them of the trial allocation . After assessment had confirmed a participant 's suitability for r and omization , the coordinator contacted the trial office by telephone for allocation . The study was not blinded . Description of Nonsurgical and Surgical Interventions Common Program We instructed and encouraged all patients to follow appropriate lifestyle behavior of good eating practice s and increased exercise and activity . We also encouraged them to exercise for at least 200 minutes per week . Nonsurgical Program This program centered on the use of behavioral modification , very-low-calorie diet , and pharmacotherapy with education and professional support on appropriate eating and exercise behavior . During the 2-year period , 3 trained physicians developed a program using all the available modalities for each individual on the basis of guidelines prepared and continually review ed by a panel of experienced bariatric physicians . The program began with an intensive 6-month period of very-low-calorie diet ( 500 to 550 kcal/d ) using 1 to 3 packets of Optifast ( Novartis , Fremont , Michigan ) daily for 12 weeks , followed by a transition phase over 4 weeks combining some very-low-calorie meals with 120 mg of orlistat before nonvery-low-calorie diet meals , and then 120 mg of orlistat before all meals until the completion of the intensive phase . This intensive 6-month program was followed by further courses of very-low-calorie diets or orlistat as tolerated , as well as continual behavioral , dietary , and exercise advice to assist the participant in maintaining weight loss over a prolonged period . Sibutramine was not approved for use in Australia during the first 12 months of the study and , therefore , was not incorporated into the medical program . The management program for each individual was design ed to reflect good clinical practice . A physician saw each patient every 2 weeks during the very-low-calorie diet program and every 4 to 6 weeks during the rest of the study . All patients were seen at least every 6 weeks . Surgical Program Two experienced surgeons performed the laparoscopic adjustable gastric b and ( LAP-B AND System ) procedure , by a st and ardized method ( 14 ) , within 1 month of r and omization . The b and was placed along the perigastric pathway in all cases ( 16 ) . The treating surgeon review ed patient progress every 4 to 6 weeks during the study period and made adjustments to the volume of saline within the b and in the office by using st and ard clinical criteria ( 17 ) . Adverse Events All patients in the study were question ed about the occurrence of adverse events at each consultation , and physicians recorded the The present study was design ed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance , dietary , and physical activity habits and eating behavior of patients following vertical b and ed gastroplasty ( VBG ) . Thirty severely obese female volunteers were included in the study and they were r and omly assigned to one of two intervention groups : usual care ( UC ) or lifestyle intervention ( LS ) group . Patients were followed for 3 years postoperatively . Outcome measures included weight loss , dietary habits , physical activity level ( PAL ) , and eating behavior changes . Weight was significantly lower in the LS group after 12 months ( 84.4 + /- 3.9 kg vs. 98.4 + /- 4.4 kg , P < 0.05 ) , 24 months ( 83.0 + /- 3.3 vs. 101.9 + /- 5.3 kg , P < 0.05 ) , and 36 months following surgery ( 84.2 + /- 3.3 vs. 102.5 + /- 3.5 kg , P < 0.05 ) . Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing . With regard to eating behavior , the LS group scored significantly better in total Dutch Eating Behavior Question naire ( DEBQ ) , Restraint Eating and External Eating scales at all postoperative time points . Similarly , significant differences were found between the two groups in dietary intake . These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery . The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity BACKGROUND Nocturnal hypertension , increased night-to-day systolic blood pressure ( BP ) ratio and nondipper status ( night-to-day systolic BP ratio > 0.9 ) are associated with an increased risk of cardiovascular disease . Our aim was to compare the 1-year effect of Roux-en-Y gastric bypass ( RYGB ) versus a program of intensive lifestyle intervention ( ILI ) only on nocturnal hypertension and circadian BP rhythm . METHODS The study participants were part of a 1-year , controlled clinical trial comparing the effect of RYGB or ILI on obesity-related comorbidities . Ninety participants ( 49 in the RYGB group ) successfully completed 24-hour ambulatory BP monitoring  at baseline and follow-up and were eligible subsequently for analysis . RESULTS A total of 71 subjects ( 79 % ) had nocturnal hypertension at baseline . The number of subjects with nocturnal hypertension decreased from 42 to 14 in the RYGB group ( P ≤ .001 ) and from 29 to 27 ( P = .791 ) in the ILI group . Subjects in the RYGB group had a lesser adjusted odds ratio ( OR ) of nocturnal hypertension at follow-up ( OR 0.15 ; 95 % confidence interval , 0.05 - 0.42 ; P ≤ .001 ) ; however , after further adjustment for weight loss , there was no additional beneficial effect of RYGB ( P = .674 ) . No differences between groups regarding improvement in the night-to-day systolic BP ratio were found after adjustment for 24-hour systolic pressure ( P = .107 ) . Both interventions showed a decrease in the proportion of subjects classified as nondippers , namely , 44 % ( P ≤ .001 ) and 28 % ( P = .002 ) in the RYGB and ILI groups , respectively . CONCLUSION Only RYGB was associated with a decrease in the prevalence of nocturnal hypertension . Both interventions showed an improvement in dipper status , although RYGB was more effective Objective The effects of various weight loss strategies on pancreatic beta cell function remain unclear . We aim ed to compare the effect of intensive lifestyle intervention ( ILI ) and Roux-en-Y gastric bypass surgery ( RYGB ) on beta cell function . Design One year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods One hundred and nineteen morbidly obese participants without known diabetes from the MOBIL study ( mean ( s.d . ) age 43.6 ( 10.8 ) years , body mass index ( BMI ) 45.5 ( 5.6 ) kg/m2 , 84 women ) were allocated to RYGB ( n=64 ) or ILI ( n=55 ) . The patients underwent repeated oral glucose tolerance tests ( OGTTs ) and were categorised as having either normal ( NGT ) or abnormal glucose tolerance ( AGT ) . Twenty-nine normal-weight subjects with NGT ( age 42.6 ( 8.7 ) years , BMI 22.6 ( 1.5 ) kg/m2 , 19 women ) served as controls . OGTT-based indices of beta cell function were calculated . Results One year weight reduction was 30 % ( 8) after RYGB and 9 % ( 10 ) after ILI ( P<0.001 ) . Disposition index ( DI ) increased in all treatment groups ( all P<0.05 ) , although more in the surgery groups ( both P<0.001 ) . Stimulated proinsulin-to-insulin ( PI/I ) ratio decreased in both surgery groups ( both P<0.001 ) , but to a greater extent in the surgery group with AGT at baseline ( P<0.001 ) . Post surgery , patients with NGT at baseline had higher DI and lower stimulated PI/I ratio than controls ( both P<0.027 ) . Conclusions Gastric bypass surgery improved beta cell function to a significantly greater extent than ILI . Supra-physiological insulin secretion and proinsulin processing may indicate excessive beta cell function after gastric bypass surgery Objective : As large weight losses are rarely achieved through any method except bariatric surgery , there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means .  The National Weight Control Registry ( NWCR ) provides a re source for making such unique comparisons . This study compared the amount of weight regain , behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods . Design :  Surgical participants ( n=105 ) were matched with two non-surgical participants ( n=210 ) on gender , entry weight , maximum weight loss and weight-maintenance duration , and compared prospect ively over 1 year . Results : Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ⩾13.6 kg off for 5.5±7.1 years . Both groups gained small but significant amounts of weight from registry entry to 1 year ( P=0.034 ) , but did not significantly differ in magnitude of weight regain ( 1.8±7.5 and 1.7±7.0 kg for surgical and non-surgical groups , respectively ; P=0.369 ) . Surgical participants reported less physical activity , more fast food and fat consumption , less dietary restraint , and higher depression and stress at entry and 1 year . Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups . Conclusions : Despite marked behavioral differences between the groups , significant differences in weight regain were not observed . The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts . Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery Introduction Roux-en-Y gastric bypass ( RYGB ) is considered the gold st and ard bariatric procedure with documented safety and effectiveness . Laparoscopic sleeve gastrectomy ( LSG ) is a newer procedure being done with increasing frequency . R and omized comparisons of LSG and other bariatric procedures are limited . We present the results of the first prospect i ve r and omized trial comparing LSG and RYGB in the Polish population . Aim To assess the efficacy and safety of LSG versus RYGB in the treatment of morbid obesity and obesity-related comorbidities . Material and methods Seventy-two morbidly obese patients were r and omized to RYGB ( 36 patients ) or LSG ( 36 patients ) . Both groups were comparable regarding age , gender , body mass index ( BMI ) and comorbidities . The follow-up period was at least 12 months . Baseline and 6 and 12 month outcomes were analyzed including assessment of percent excess weight lost ( % EWL ) , reduction in BMI , morbidity ( minor , major , early and late complications ) , mortality , reoperations , comorbidities and nutritional deficiencies . Results There was no 30-day mortality and no significant difference in major complication rate ( 0 % after RYGB and 8.3 % after LSG , p > 0.05 ) or minor complication rate ( 16.6 % after RYGB and 10.1 % after LSG , p > 0.05 ) . There were no early reoperations after RYGB and 2 after LSG ( 5.5 % ) ( p > 0.05 ) . Weight loss was significant after RYGB and LSG but there was no difference between both groups at 6 and 12 months of follow-up . At 12 months % EWL in RYGB and LSG groups reached 64.2 % and 67.6 % respectively ( p > 0.05 ) . There was no significant difference in the overall prevalence of comorbidities and nutritional deficiencies . Conclusions Both LSG and RYGB produce significant weight loss at 6 and 12 months after surgery . The procedures are equally effective with regard to % EWL , reduction in BMI and amelioration of comorbidities at 6 and 12 months of follow-up . Laparoscopic sleeve gastrectomy and RYGB are comparably safe techniques with no significant differences in minor and major complication rates at 6 and 12 months Objective : Laparoscopic sleeve gastrectomy ( LSG ) has been proposed as an effective alternative to the current st and ard procedure , laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . Prospect i ve data comparing both procedures are rare . Therefore , we performed a r and omized clinical trial assessing the effectiveness and safety of these 2 operative techniques . Methods : Two hundred seventeen patients were r and omized at 4 bariatric centers in Switzerl and . One hundred seven patients underwent LSG using a 35-F bougie with suturing of the stapler line , and 110 patients underwent LRYGB with a 150-cm antecolic alimentary and a 50-cm biliopancreatic limb . The mean body mass index of all patients was 44 ± 11.1 kg/m2 , the mean age was 43 ± 5.3 years , and 72 % were female . Results : The 2 groups were similar in terms of body mass index , age , sex , comorbidities , and eating behavior . The mean operative time was less for LSG than for LRYGB ( 87 ± 52.3 minutes vs 108 ± 42.3 minutes ; P = 0.003 ) . The conversion rate was 0.9 % in both groups . Complications ( < 30 days ) occurred more often in LRYGB than in LSG ( 17.2 % vs 8.4 % ; P = 0.067 ) . However , the difference in severe complications did not reach statistical significance ( 4.5 % for LRYGB vs 1 % for LSG ; P = 0.21 ) . Excessive body mass index loss 1 year after the operation was similar between the 2 groups ( 72.3 % ± 22 % for LSG and 76.6 % ± 21 % for LRYGB ; P = 0.2 ) . Except for gastroesophageal reflux disease , which showed a higher resolution rate after LRYGB , the comorbidities and quality of life were significantly improved after both procedures . Conclusions : LSG was associated with shorter operation time and a trend toward fewer complications than with LRYGB . Both procedures were almost equally efficient regarding weight loss , improvement of comorbidities , and quality of life 1 year after surgery . Long-term follow-up data are needed to confirm these facts OBJECTIVES To determine the efficacies of 2 weight-reducing operations on diabetic control and the role of duodenum exclusion . DESIGN Double-blind r and omized controlled trial . SETTING Department of Surgery of the Min-Sheng General Hospital , National Taiwan University . PATIENTS We studied 60 moderately obese patients ( body mass index > 25 and < 35 ) aged > 30 to < 60 years who had poorly controlled type 2 diabetes mellitus ( T2DM ) ( hemoglobin A(1c ) [ HbA(1c ) ] > 7.5 % ) after conventional treatment ( > 6 months ) from September 1 , 2007 , through June 30 , 2008 . Patients and observers were masked during the follow-up , which ended in 2009 , 1 year after final enrollment . INTERVENTIONS Gastric bypass with duodenum exclusion ( n = 30 ) vs sleeve gastrectomy without duodenum exclusion ( n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was remission of T2DM ( fasting glucose < 126 mg/dL and HbA(1c ) < 6.5 % without glycemic therapy ) . Secondary measures included weight and metabolic syndrome . Analysis was by intention to treat . RESULTS Of the 60 patients enrolled , all completed the 12-month follow-up . Remission of T2DM was achieved by 28 ( 93 % ) in the gastric bypass group and 14 ( 47 % ) in the sleeve gastrectomy group ( P = .02 ) . Participants assigned to gastric bypass had lost more weight , achieved a lower waist circumference , and had lower glucose , HbA(1c ) , and blood lipid levels than the sleeve gastrectomy group . No serious complications occurred in either group . CONCLUSIONS Participants r and omized to gastric bypass were more likely to achieve remission of T2DM . Duodenum exclusion plays a role in T2DM treatment and should be assessed . Trial Registration clinical trials.gov Identifier : NCT00540462 ( http://www . clinical trials.gov ) BACKGROUND The surgical treatment of diabetes had witnessed progressive development and success since the first case of pancreatic transplantation . Although this was a great step , wide clinical application was limited by several factors . Bariatric surgery such as gastric bypass is emerging as a promising option in obese patients with type 2 diabetes . The aim of this article is to explore the current application of gastric bypass in patients with type 2 diabetes and the theoretical bases of gastric bypass as a treatment option for type 1 diabetes . METHODS We performed a MEDLINE search for articles published from August 1955 to December 2008 using the words " surgical treatment of diabetes , " " etiology of diabetes " and " gastric bypass . " RESULTS We identified 3215 studies and selected 72 relevant papers for review . Surgical treatment of diabetes is evolving from complex pancreatic and islets transplantation surgery for type 1 diabetes with critical postoperative outcome and follow-up to a metabolic surgery , including gastric bypass . Gastric bypass ( no immune suppression or graft rejection ) has proven to be highly effective treatment for obese patients and nonobese animals with type 2 diabetes . There are certain shared criteria between types 1 and 2 diabetes , making a selected spectrum of the disease a potential target for metabolic surgery to improve or cure diabetes . CONCLUSION Roux-en-Y gastric bypass is a promising option for lifelong treatment of type 2 diabetes . It has the potential to improve or cure a selected spectrum of type 1 diabetes when performed early in the disease . Further animal model studies or r and omized controlled trials are needed to support our conclusion Objectives : This prospect i ve , r and omized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) and laparoscopic mini-gastric bypass ( LMGBP ) in the treatment of morbid obesity . Summary Background Data : LRYGBP has been the gold st and ard for the treatment of morbid obesity . While LMGBP has been reported to be a simple and effective treatment , data from a r and omized trial are lacking . Methods : Eighty patients who met the NIH criteria were recruited and r and omized to receive either LRYGBP ( n = 40 ) or LMGBP ( n = 40 ) . The minimum postoperative follow-up was 2 years ( mean , 31.3 months ) . Perioperative data were assessed . Late complication , excess weight loss , BMI , quality of life , and comorbidities were determined . Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index ( GIQLI ) . Results : There was one conversion ( 2.5 % ) in the LRYGBP group . Operation time was shorter in LMGBP group ( 205 versus 148 , P < 0.05 ) . There was no mortality in each group . The operative morbidity rate was higher in the LRYGBP group ( 20 % versus 7.5 % , P < 0.05 ) . The late complications rate was the same in the 2 groups ( 7.5 % ) with no reoperation . The percentage of excess weight loss was 58.7 % and 60.0 % at 1 and 2 years , respectively , in the LPYGBP group , and 64.9 % and 64.4 % in the LMGBP group . The residual excess weight < 50 % at 2 years postoperatively was achieved in 75 % of patients in the LRYGBP group and 95 % in the LMGBP group ( P < 0.05 ) . A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted . Both gastrointestinal quality of life increased significantly without any significant difference between the groups . Conclusion : Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life .  LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up Background Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term . The objective of this paper is to determine the long-term ( 10 years ) outcome for patients from a r and omised controlled trial ( RCT ) . Methods A RCT in 2002 compared laparoscopic adjustable gastric b and ( LAGB ) for obesity  with non-surgical therapy . Follow-up has been conducted at 10 years . Eighty patients ( BMI 30–35 ) were r and omised to a non-surgical or a surgical program .  Outcome data are available on 37 ( 92.5 % ) of the surgical patients and 27 ( 62.5 % ) of the non-surgical patients at 10 years . Results Weight change , the metabolic syndrome , quality of life , adverse events and direct costs of the surgical cohort were the main results of the study . A durable weight loss is present in the surgical group with a mean ( SD ) 10-year weight loss of 14.1 ( 7.7 ) kg ( 63.4 % EWL ) , better than the non-surgical group ( mean ( SD ) = 0.4 ( 10.5 ) kg ; p < 0.001 ) . The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups . Proximal gastric enlargements occurred in 17 ( 30 % ) of the 57 who had LAGB and removal of the b and occurred in 7 ( 12 % ) . The annual maintenance costs including additional surgery was AUD $ 765 per patient per year . Conclusions Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy . There is also a sustained reduction of the metabolic syndrome . There is a significant maintenance requirement after LAGB BACKGROUND Bariatric surgery is widely performed to induce weight loss . OBJECTIVE The objective was to examine changes in vitamin status after 2 bariatric surgical techniques . DESIGN A r and omized controlled trial was conducted in 2 Sc and inavian hospitals . The subjects were 60 superobese patients [ body mass index ( BMI ; in kg/m(2 ) ) : 50 - 60 ] . The surgical interventions were either laparoscopic Roux-en-Y gastric bypass or laparoscopic biliopancreatic diversion with duodenal switch . All patients received multivitamins , iron , calcium , and vitamin D supplements . Gastric bypass patients also received a vitamin B-12 substitute . The patients were examined before surgery and 6 wk , 6 mo , and 1 y after surgery . RESULTS Of 60 surgically treated patients , 59 completed the follow-up . After surgery , duodenal switch patients had lower mean vitamin A and 25-hydroxyvitamin D concentrations and a steeper decline in thiamine concentrations than did the gastric bypass patients . Other vitamins ( riboflavin , vitamin B-6 , vitamin C , and vitamin E adjusted for serum lipids ) did not change differently in the surgical groups , and concentrations were either stable or increased . Furthermore , duodenal switch patients had lower hemoglobin and total cholesterol concentrations and a lower BMI ( mean reduction : 41 % compared with 30 % ) than did gastric bypass patients 1 y after surgery . Additional dietary supplement use was more frequent among duodenal switch patients ( 55 % ) than among gastric bypass patients ( 26 % ) . CONCLUSIONS Compared with gastric bypass , duodenal switch may be associated with a greater risk of vitamin A and D deficiencies in the first year after surgery and of thiamine deficiency in the initial months after surgery . Patients who undergo these 2 surgical interventions may require different monitoring and supplementation regimens in the first year after surgery . This trial was registered at Clinical Trials.gov as NCT00327912 AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation Background : Laparoscopic adjustable gastric b and ing ( GB ) is the most popular restrictive procedure for obesity in Europe . Isolated sleeve gastrectomy ( SG ) , is less common , but more invasive and with a higher learning curve . The aim of this prospect i ve r and omized study was to compare the results of GB and SG after 1 and 3 years of surgery . Methods : 80 patient c and i date s for laparoscopic restrictive surgery were operated consecutively and r and omly , between January and December 31 , 2002 , by GB ( 7 M , 33F ) or by SG ( 9 M , 31F ) ( NS ) . Median age was 36 ( 20 - 61 ) for GB versus 40 ( 22 - 65 ) for SG ( NS ) . Median BMI was 37 ( 30 - 47 ) for GB versus 39 ( 30 - 53 ) for SG ( NS ) . After 1 and 3 years : weight loss , feeling of hunger , sweet eating , gastroesophageal reflux disease ( GERD ) , complications and re-operations were recorded in both groups . Results : Median weight loss after 1 year was 14 kg ( −5 to + 38 ) for GB and 26 kg ( 0 to 46 ) for SG ( P<0.0001 ) ; and after 3 years was 17 kg ( 0 to 40 ) for GB and 29.5 kg ( 1 to 48 ) for SG ( P<0.0001 ) . Median decrease in BMI after 1 year was 15.5 kg/m 2 ( 5 to 39 ) after GB and 25 kg/m2 ( 0 to 45 ) after SG ( P<0.0001 ) ; and after 3 years was 18 kg/m2 ( 0 to 39 ) after GB and 27.5 kg/m 2 ( 0 to 48 ) after SG ( P=0.0004 ) . Median % EWL at 1 year was 41.4 % ( −11.8 to + 130.5 ) after GB and 57.7 % ( 0 to 125.5 ) after SG ( P=0.0004 ) ; and at 3 years was 48 % ( 0 to 124.8 ) after GB and 66 % ( −3.1 to + 152.4 ) after SG ( P=0.0025 ) . Loss of feeling of hunger after 1 year was registered in 42.5 % of patients with GB and in 75 % of patients with SG ( P=0.003 ) ; and after 3 years in 2.9 % of patients with GB and 46.7 % of patients with SG ( P<0.0001 ) . Loss of craving for sweets after 1 year was achieved in 35 % of patients with GB and 50 % of patients with SG ( NS ) ; and after 3 years in 2.9 % of patients with GB and 23 % of patients with SG ( NS ) . GERD appeared de novo after 1 year in 8.8 % of patients with GB and 21.8 % of patients with SG ( NS ) ; and after 3 years in 20.5 % of patients with GB and 3.1 % of patients with SG ( NS ) . Postoperative complications requiring re-operation were necessary for 2 patients after SG . Late complications requiring re-operation after GB included 3 pouch dilations treated by b and removal in 2 and 1 laparoscopic conversion to Roux-en-Y gastric bypass  ( RYGBP ) , 1 gastric erosion treated by conversion to RYGBP , and 3 disconnections of the system treated by reconnection . Inefficacy affected 2 patients after GB , treated by conversion into RYGBP and 2 patients after SG treated by conversion to duodenal switch . Conclusion : Weight loss and loss of feeling of hunger after 1 year and 3 years are better after SG than GB . GERD is more frequent at 1 year after SG and at 3 years after GB . The number of re-operations is important in both groups , but the severity of complications appears higher in SG Background : Gastric bypass and adjustable gastric b and ing are the 2 most commonly performed bariatric procedures for the treatment of morbid obesity . The aim of this study was to compare the outcomes , quality of life , and costs of laparoscopic gastric bypass versus laparoscopic gastric b and ing . Study Design : Between 2002 and 2007 , 250 patients with a body mass index of 35 to 60 kg/m2 were r and omly assigned to gastric bypass or gastric b and ing . After exclusion , 111 patients underwent gastric bypass and 86 patients underwent gastric b and ing .  Outcome measures included demographic data , operative time , blood loss , length of hospital stay , morbidity , mortality , early and late reoperation rate , weight loss , changes in quality of life , and cost . Treatment failure was defined as losing less than 20 % of excess weight or conversion to another bariatric operation for failure of weight loss . Results : There were no deaths at 90 days in either group . The mean body mass index was higher in the gastric bypass group ( 47.5 vs. 45.5 kg/m2 , respectively , P < 0.01 ) while the mean age was higher in the gastric b and group ( 45 vs. 41 years , respectively , P < 0.01 ) . Compared with gastric b and ing , operative blood loss was higher and the mean operative time and length of stay were longer in the gastric bypass group . The 30-day complication rate was higher after gastric bypass ( 21.6 % vs. 7.0 % for gastric b and ) ; however , there were no life-threatening complications such as leaks or sepsis . The most frequent late complication in the gastric bypass group was stricture ( 14.3 % ) . The 1-year mortality was 0.9 % for the gastric bypass group and 0 % for the gastric b and group . The percent of excess weight loss at 4 years was higher in the gastric bypass group ( 68 ± 19 % vs. 45 ± 28 % , respectively , P < 0.05 ) . Treatment failure occurred in 16.7 % of the patients who underwent gastric b and ing and in 0 % of those who underwent gastric bypass , with male gender being a predictive factor for poor weight loss after gastric b and ing . At 1-year postsurgery , quality of life improved in both groups to that of US norms . The total cost was higher for gastric bypass as compared with gastric b and ing procedure ( $ 12,310 vs. $ 10,766 , respectively , P < 0.01 ) . Conclusions : Laparoscopic gastric bypass and gastric b and ing are both safe and effective approaches for the treatment of morbid obesity . Gastric bypass result ed in better weight loss at medium- and long-term follow-up but was associated with more perioperative and late complications and a higher 30-day readmission rate . There was a wide variation in weight loss after gastric b and ing with a small proportion of patients considered as treatment failure , and male gender was a predictive factor for poor weight loss OBJECTIVE To assess changes in body composition with weight loss in obese subjects r and omized to a laparoscopic adjustable gastric b and surgical program or a medical program using a very-low-energy diet and orlistat .  RESEARCH METHODS AND PROCEDURES Using body composition measurements by DXA , neutron activation for total body nitrogen , and whole body gamma counting for total body potassium , we studied changes in fat mass , fat distribution , fat-free mass , total bone mineral content , total body protein , and body cell mass at 6 ( n = 61 paired ) and 24 months ( n = 53 paired ) after r and omization . RESULTS At 24 months , the surgical group had lost significantly more weight ( surgical , 20.3 + /- 6.5 kg ; medical , 5.9 + /- 8.0 kg ) . There was favorable fat-free mass to fat mass loss ratios for both groups ( surgical , 1:5.5 ; medical , 1:5.9 ) . Changes in total body nitrogen or potassium were favorable in each group . A small reduction in mean bone mineral content occurred throughout the study but was not associated with extent of weight loss or treatment group . At 6 months , weight loss for both groups was similar ( surgical , 14.1 + /- 4.5 kg ; medical , 13.3 + /- 7.3 kg ) . The medical program subjects lost less fat-free mass and skeletal muscle and had increased total body protein . The proportion of body fat to limb fat remained remarkably constant throughout the study . DISCUSSION Weight loss programs used in this study induced fat loss without significant deleterious effects on the components of fat-free mass Background : The endoscopically placed duodenal-jejunal bypass sleeve or EndoBarrier Gastrointestinal Liner has been design ed to achieve weight loss in morbidly obese patients . We report on the first European experience with this device . Methods : A multicenter , r and omized clinical trial was performed . Forty-one patients were included and 30 underwent sleeve implantation . Eleven patients served as a diet control group . All patients followed the same low-calorie diet during the study period . The purpose of the study was to determine the safety and efficacy of the device . Results : Twenty-six devices were successfully implanted . In 4 patients , implantation could not be achieved . Four devices were explanted prior to the initial protocol end point because of migration ( 1 ) , dislocation of the anchor ( 1 ) , sleeve obstruction ( 1 ) , and continuous epigastric pain ( 1 ) . The remaining patients all completed the study . Mean procedure time was 35 minutes ( range : 12–102 minutes ) for a successful implantation and 17 minutes ( range : 5–99 minutes ) for explantation . There were no procedure related adverse events . During the study period the 26 duodenal-jejunal bypass sleeve patients ( 100 % ) had at least one adverse event , mainly abdominal pain and nausea during the first week after implantation . Initial mean body mass index ( BMI , kg/m2 ) was 48.9 and 47.4 kg/m2 for the device and control patients , respectively . Mean excess weight loss after 3 months was 19.0 % for device patients versus 6.9 % for control patients ( P < 0.002 ) . Absolute change in BMI at 3 months was 5.5 and 1.9 kg/m2 , respectively . Type 2 diabetes mellitus was present at baseline in 8 patients of the device group and improved in 7 patients during the study period ( lower glucose levels , HbA1c , and medication requirements ) . Conclusion : The EndoBarrier Gastrointestinal Liner is a feasible and safe noninvasive device with excellent short-term weight loss results . The device also has a significant positive effect on type 2 diabetes mellitus . Long-term r and omized and sham studies for weight loss and treatment of diabetes are necessary to determine the role of the device in the treatment of morbid obesity . This study was registered at www . clinical trials.gov ( registration number : NCT00830440 ) BACKGROUND Laparoscopic gastric plication ( LGP ) is emerging as a safe and effective bariatric procedure . However , there are no reports on the comparison between the efficacy and complications of LGP and laparoscopic mini-gastric bypass ( LMGB ) , which is still an investigational bariatric procedure . The objective of this study was to compare safety and efficacy of LGP and LMGB in the treatment of morbid obesity in a one-year follow-up study . METHODS Forty patients met the National Institutes of Health criteria and were r and omly assigned to receive either LGP ( n = 20 ) or LMGB ( n = 20 ) by a block r and omization method . Early and late complications , body mass index ( BMI ) , excess weight loss , and obesity-related co-morbidities were determined at the 1-year follow-up . RESULTS Operative time and mean length of hospitalization were shorter in the LGP group ( 71.0 minutes versus 125.0 minutes , P<.001 , and 1.6 days versus 5.2 days ; P<.001 , respectively ) . The mean percentage of excess weight loss ( % EWL ) at 12 months follow-up was 66.9 % in the LMGB group and 60.8 % in the LGP group ( P = .34 ) . Improvement was observed in all co-morbidities in both groups , with the exception of hyperlipidemia , which remained unresolved in 4 patients . Lower incidence of iron deficiency occurred in the LGP group ( P = .035 ) . Rehospitalization and reoperation were not required in any cases . Considering the cost of instruments used in the LMGB procedure and operative time , LGP saved approximately $ 2,500 per case compared with LMGB . CONCLUSION Both LGP and LMGB are effective weight loss procedures .  LGP proved to be a simpler and less costly procedure compared with LMGB with a lower risk of iron deficiency during a 1-year follow-up study Objective To explore efficacy and safety of laparoscopic sleeve gastrectomy for the treatment of obesity . Methods Forty patients underwent laparoscopic sleeve gastrectomy as a treatment option for weight reduction between December 2006 and February 2010.Mean  preoperative body weight (BW),body mass index ( BMI ) and exceed body weight ( EBW ) were(104.2 ±3.3 ) kg,(36.9 ± 1.0 ) kg/m2 and ( 37.8 ±3.0 ) kg , respectively . Outcome data were collected and assessed prospect ively . Results Laparoscopic procedures were completed in all patients , with no conversion to open surgery . The operation time averaged ( 80 ± 18 ) min , and there were no severe postoperative complications . The median postoperative hospital stay was ( 5.5 ± 1.5 ) days . BMI loss was ( 4.3 ± 1.7 ) kg/m2 , ( 7.0 ± 1.9 ) kg/m2,(9.3 ±3.1 ) kg/m2 and ( 10.1 ±3.8 ) kg/m2,respectively , and percentage of EBW loss was 35.0％ ± 13.5％,57.1％ ± 17.7％,74.2％ ±27.2％ , and 81.8％ ±29.4％,respectively , at 1,3,6 , and 12 months following the procedure . Conclusion Laparoscopic sleeve gastrectomy is an effective and safe surgical option for the treatment of obesity with lower BMI .Additional long-term studies are still needed to accurately compare laparoscopic sleeve gastrectomy with other procedures of weight reduction . Key words : Obesity , morbid ; Laparoscopy ; BACKGROUND Obesity is a rising threat to public health . The relative increase in the incidence of morbid obesity is most pronounced in the most severely obese .  Roux-en-Y gastric bypass ( RYGB ) results in inferior weight loss in this group . Therefore , we have offered biliopancreatic diversion with duodenal switch ( BPD/DS ) as an alternative for this patient category . Our objective was to compare BPD/DS and RYGB in the surgical treatment of morbid obesity in patients with a body mass index ( BMI ) > 48 kg/m(2 ) . The setting was a university hospital in Sweden . METHODS In a controlled trial ( registration number IS RCT N10940791 ) , 47 patients ( 25 men , BMI 54.5 ± 6.1 kg/m(2 ) ) were r and omized to RYGB ( n = 23 ) or BPD/DS ( n = 24 ) . Biochemical data were collected preoperatively and 1 and 3 years postoperatively . A question naire addressing weight , general satisfaction , and gastrointestinal symptoms was distributed a median of 4 years postoperatively . RESULTS Both procedures were safe . The duration of surgery and postoperative morphine consumption were greater after BPD/DS than after RYGB ( 157 versus 117 min and 140 versus 93 mg , respectively ) . BPD/DS result ed in greater weight loss  than RYGB ( -23.2 ± 4.9 versus -16.2 ± 6.9 BMI units or 80 % ± 15 % versus 51 % ± 23 % excess BMI loss , P < .001 ) . BPD/DS  yielded lower glucose and glycated hemoglobin levels at 3 years . More patients listed troublesome diarrhea and malodorous flatus in the question naire after BPD/DS , but no significant difference was seen ( P = .078 and P = .073 , respectively ) . CONCLUSIONS BPD/DS produced superior weight results and lower glycated hemoglobin levels compared with RYGB in patients with a BMI > 48 kg/m(2 ) . Both operations yield high satisfaction rates . However , diarrhea tended to be more common after BPD/DS Background This study presents late results of a previously published 2-year prospect i ve comparison between Roux-en-Y gastric bypass ( RYGBP ) versus biliopancreatic diversion with Roux-en-Y gastric bypass ( BPD-RYGBP ) in an exclusively non-superobese population . Methods From a cohort of 130 patients with a BMI of 35–50 kg/m2 , 65 were r and omly selected to undergo RYGBP and 65 to BPD-RYGBP .  All underwent follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results Follow-up at the eighth year was achieved in 60 % of the BPD-RYGBP and in 58 % of the RYGBP group ( p = 1.00 ) . Mean excess weight loss ( EWL% ) , was significantly higher following BPD-RYGBP ( 76.89 ± 1.53 ) as compared to RYGBP ( 67.17 ± 1.43 ) ( p = 0.0004 ) . The mean success rate ( percentage of patients with EWL% ≥50 % ) was significantly higher after BPD-RYGBP ( 95.85 ± 1.01 ) than RYGBP ( 75.91 ± 3.58 ) ( p = 0.0001 ) . No significant differences were observed for late non-metabolic complications . The incidence of anemia , iron deficiency , B12 deficiency , and low-ferritin levels was relatively high in both groups with not always significant differences . Severe protein malnutrition occurred in four patients ( three BPD-RYGBP and one RYGBP ) ( p = 0.37 ) . In only one BPD-RYGBP patient ( 1.54 % ) was revision surgery to RYGBP necessary , due to recurrent episodes of hypoproteinemia . The remaining patients were treated successfully with total parenteral nutrition and nutritional counseling . Conclusions Late results presented in this paper agree with the previously published 2-year results of the same patient cohort . Although both procedures are safe and effective  , BPD-RYGBP seems to prevail in terms of successful weight loss without a significantly higher incidence of metabolic and non-metabolic complications Obesity adversely affects myocardial metabolism , efficiency , and diastolic function . Our objective was to determine whether weight loss can ameliorate obesity-related myocardial metabolism and efficiency derangements and that these improvements directly relate to improved diastolic function in humans . We studied 30 obese ( BMI > 30 kg/m2 ) subjects with positron emission tomography ( PET ) ( myocardial metabolism , blood flow ) and echocardiography ( structure , function ) before and after marked weight loss from gastric bypass surgery ( N = 10 ) or moderate weight loss from diet ( N = 20 ) .  Baseline BMI , insulin resistance , hemodynamics , left ventricular ( LV ) mass , systolic function , myocardial oxygen consumption ( MVO2 ) , and fatty acid ( FA ) metabolism were similar between the groups . MVO2/g decreased after diet-induced weight loss ( P = 0.009 ) . Total MVO2 decreased after dietary ( P = 0.02 ) and surgical weight loss ( P = 0.0006 ) and was related to decreased BMI ( P = 0.006 ) . Total myocardial FA utilization decreased ( P = 0.03 ) , and FA oxidation trended lower ( P = 0.06 ) only after surgery . FA esterification and LV efficiency were unchanged . After surgical weight loss , LV mass decreased by 23 % ( Doppler-derived ) E/E ' by 33 % , and relaxation increased ( improved ) by 28 % . Improved LV relaxation related significantly to decreased BMI , insulin resistance , total MVO2 , and LV mass but not FA utilization . Decreased total MVO(2 ) predicted LV relaxation improvement independent of BMI change ( P = 0.02 ) . Weight loss can ameliorate the obesity-related derangements in myocardial metabolism and LV structure and diastolic function . Decreased total MVO2 independently predicted improved LV relaxation , suggesting that myocardial oxygen metabolism may be mechanistically important in determining cardiac relaxation Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life . We prospect ively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale ( ESS ) and the Short Form-12 . Participants ( n = 223 ; 79 % women ) with a mean body mass index ( BMI ) and ESS of 44.8 ± 7.9 kg/m2 and 7.9 ± 4.5 , respectively , received a vertical gastrectomy ( 76 % ) or Roux-en-Y gastric bypass ( 12 % ) . Preoperatively , 30 % of patients complained of excessive daytime sleepiness ( ESS > 10 ) . Patients with preoperative excessive daytime sleepiness were more obese ( p = 0.002 ) , had higher fasting glucose levels ( p = 0.02 ) , more likely to have a diagnosis of sleep-disordered breathing ( p < 0.001 ) , report snoring ( p < 0.001 ) , and had lower health-related quality of life measures particularly physical function ( p < 0.001 ) , depression ( p = 0.006 ) , and sexual satisfaction ( p = 0.04 ) than non-sleepy patients . At 12-months postoperatively , most patients experienced a significant reduction in BMI ( 28.6 ± 5.5 kg/m2 , p < 0.001 ) and excessive daytime sleepiness ( mean ESS 5.3 ± 3.3 , p < 0.001 ) . Patients with a clinical ly relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function ( p = 0.009 ) and snoring ( p = 0.010 ) and were more likely still using positive airway pressure therapy ( p = 0.032 ) than patients without a clinical ly relevant improvement . Statistically and clinical ly significant improvements in all health-related quality of life measures were noted at 24 months . Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness The goal of this study was to underst and the mechanisms of greater weight loss by  gastric bypass ( GBP )  compared to gastric b and ing ( GB ) surgery .  Obese weight- and age-matched subjects were studied before ( T0 ) , after a 12 kg weight loss ( T1 ) by GBP ( n = 11 ) or GB ( n = 9 ) , and at 1 year after surgery ( T2 ) . peptide YY(3 - 36 ) ( PYY(3 - 36 ) ) , ghrelin , glucagon-like peptide-1 ( GLP-1 ) , leptin , and amylin were measured after an oral glucose challenge . At T1 , glucose-stimulated GLP-1 and PYY levels increased significantly after GBP but not GB . Ghrelin levels did not change significantly after either surgery . In spite of equivalent weight loss , leptin and amylin decreased after GBP , but not after GB . At T2 , weight loss was greater after GBP than GB ( P = 0.003 ) . GLP-1 , PYY , and amylin levels did not significantly change from T1 to T2 ; leptin levels continued to decrease after GBP , but not after GB at T2 . Surprisingly , ghrelin area under the curve ( AUC ) increased 1 year after GBP ( P = 0.03 ) . These data show that , at equivalent weight loss , favorable GLP-1 and PYY changes occur after GBP , but not GB , and could explain the difference in weight loss at 1 year . Mechanisms other than weight loss may explain changes of leptin and amylin after GBP Background Laparoscopic adjustable silicone gastric b and ing ( LASGB ) and laparoscopic vertical b and ed gastroplasty ( LVBG ) are the most frequently performed restrictive operations for morbid obesity . The question of whether bariatric restrictive procedures increase or reduce gastroesophageal reflux disease ( GERD ) remains open . This study aim ed to compare the long-term results of LASGB with those of LVBG in terms of postoperative GERD and esophageal motility function . Methods From February 1999 to December 2000 , 175 patients underwent bariatric surgery .  After 75 of these patients were excluded from the study , the remaining 100 patients were r and omly assigned to one of two treatment groups : LASGB or LVBG . The end points of the study were evaluation of clinical and instrumental GERD and esophageal function . The follow-up protocol included clinical assessment using the Gastroesophageal Reflux Health-Related Quality -of-Life ( GERD-HRQOL ) scale at 3 , 12 , and 96 months . Esophageal manometry , 24-h pH monitoring , and endoscopy  were performed at 12 and 96 months . Results At 12 months , GERD had developed in 13 ( 26 % ) LASGB and 11 ( 21.6 % ) LVBG patients . In the majority of cases , GERD result ed from pouch dilation or poor compliance and required either reoperation ( ten after LASGB and three after LVBG ) or endoscopic dilation of the neopylorus ( four after LVBG ) . In all , 71 patients completed the 96-month follow-up protocol . The findings showed that three ( 11.5 % ) of 26 LASGB patients and four ( 9 % ) of 45 LVBG patients were receiving proton pump inhibitor ( PPI ) therapy for GERD . Postoperative lower esophageal sphincter ( LES ) pressure and esophageal motility did not differ from preoperative data except for the presence of aperistaltic waves in one LASGB and two LVBG symptomatic GERD patients . Conclusions No significant association between gastric restrictive procedures and GERD or esophageal function was found during long-term follow-up assessment . The increased occurrence of GERD in the early follow-up period often is due to a technical defect or poor patient compliance Background Glycemic control of type 2 diabetes mellitus ( T2DM ) remains a dilemma to physicians . Although gastric bypass surgery undertaken for morbid obesity has been shown to resolve this disease well , data on the effectiveness of duodenojejunal bypass in improving or resolving T2DM and the metabolic syndrome ( MS ) , especially in nonobese patients are scarce . This study was intended to evaluate the clinical effects of laparoscopic duodenojejunal bypass ( LDJB ) in patients with T2DM and a body mass index of < 35 kg/m2 . Methods We conducted a 12-month prospect i ve study on the changes in glucose homeostasis and the MS in seven T2DM subjects undergoing LDJB with similar DM duration , type of DM treatment , and glycemic control . Laboratory values including glycosylated hemoglobin A ( HbA1c ) , fasting blood glucose , cholesterol , triglyceride , and C-peptide were followed throughout the 12 months .  Serum levels of gastric inhibitory peptide and ghrelin were followed for 1 month .  Serum levels of gastrin and glucagon-like peptide were followed for 3 months . Results At 12 months after surgery , all subjects consistently felt relief from fatigue , pain and /or numbness in the extremities , polyuria , and polydypsia . Clinical resolution was obtained for one patient , and the preoperative diabetic medication requirements decreased for most of the other patients . The subjects demonstrated an overall improved HbA1c ( from 9.4 % to 8.5 % ) and fasting blood glucose level ( from 209 to 154 mg/dl ) . Although the change in fasting blood glucose approached statistical significance , these measures of glucose homeostasis did not achieve significance . Cholesterol and triglycerides increased slightly , and C-peptide decreased slightly over 1 year . These changes were not statistically significant . Conclusions Although this is a small series , our data show that at 12 months after surgery , clinical improvement was obvious in all of our seven patients , but LDJB may not be effective at inducing remission of T2DM and the MS in certain patients undergoing this operation . This suggests that larger patient studies should be conducted , before concluding that surgery may offer clinical and biochemical resolution to a disease once treated only medically . Longer follow-up is required for better evaluation Background Deficiencies in micronutrients after bariatric operations are frequent , despite routine supplementation . Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment . Methods Between 5/2004 and 12/2006 , 136 patients ( m : f = 0:4 ) with an average body mass index of 45 ( 35–58 ) kg/m2 and age of 53 ( 21–66 ) years were prospect ively analysed . Laparoscopic Roux-Y-gastric bypass ( LRYGB ) was performed in 86 patients and laparoscopic sleeve gastrectomy ( LSG ) was performed in 50 patients . The patients were examined before surgery as well as 3 , 6 , 12 , 24 , 30 , and 36 months postoperatively using a st and ard protocol including laboratory tests . The mean follow-up time was 24.4 ( 12–40 ) months ; the follow-up rate was 100 % . Results Prior to surgery , 57 % of the patients had at least one deficiency , 23 % of whom had vitamin D3 deficiency . Frequent postoperative deficiencies after LSG  were zinc , vitamin D3 , folic acid , iron , and vitamin B12 ; after LRYGB , vitamin B12 , vitamin D3 , zinc , and secondary hyperparathyroidism . No vitamin B1 or B6 deficiencies were found . Calcium levels were normal in all patients . Treatment of the deficiencies was mostly successful . Conclusion Preoperatively , 57 % of morbidly obese patients already had a deficiency . Postoperatively , significantly more vitamin B12 and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB . After LSG , folate deficiency was more frequent ( but not significantly so ) . Calcium levels were normal in all patients ; therefore , parathyroid hormone and vitamin D3 levels are more sensitive markers for early detection of disorders of calcium metabolism . Iron deficiency anaemia is most efficiently treated by IV therapy Background  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  is the most common bariatric technique . Laparoscopic sleeve gastrectomy ( LSG ) is a restrictive procedure ; the metabolic and endocrine effects of which remain unknown . We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels . Methods Seven patients were r and omised to LRYGB and eight to LSG .  All patients were evaluated before and at 3 and 12 months postoperatively . Plasma levels of glucose , insulin , ghrelin , leptin , peptide YY ( PYY ) , GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a st and ard test meal ingestion . Results Age , body mass index and preoperative hormone levels were similar in both groups . A significant reduction of plasma glucose and insulin levels was observed after surgery . Moreover , a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures . The fasting and postpr and ial leptin levels were significantly lower in the LRYGB group . LSG was followed by a significant reduction in fasting ghrelin levels . In the LRYGB group , GLP-1 levels increased significantly after the test meal . Conclusions LRYGB and LSG markedly improved glucose homeostasis . Only LSG decreased fasting and postpr and ial ghrelin levels , whereas GLP-1 and PYY levels increased similarly after both procedures Background Aim of the study is to present long-term results of a prospect i ve r and omized single-institution clinical trial comparing laparoscopic adjustable silicone gastric b and ing ( LASGB ) with laparoscopic vertical b and ed gastroplasty ( LVBG )  in morbid obesity . Methods A total of 100 morbidly obese patients ( body mass index 40 to 50 kg/m2 ) were r and omized to LASGB ( n = 49 ) or LVBG ( n = 51 ) and followed up for a minimum of 7 years . Results Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs ( p < 0.05 ) ; mean hospital stay was 3.7 and 6.6 days , respectively ( p < 0.05 ) . Late complication rates were 36.7 % in LASGBs vs 15.7 % in LVBGs at 3 years ( p < 0.05 ) , 46.9 % vs 43.1 % at 5 years ( NS ) , and 55.1 % vs 47.1 % at 7 years ( NS ) . Late reoperation rates were 28.6 % in LASGBs and 2.0 % in LVBGs at 3 years ( p < 0.001 ) , 38.8 % and 2.0 % at 5 years ( p < 0.001 ) , and 46.9 % and 7.8 % at 7 years ( p < 0.001 ) . Excess weight loss in LASGBs was 41.8 % at 3 years , 33.2 % at 5 years , and 29.9 % at 7 years ; excess weight loss in LVBGs was 60.9 % , 57 % , and 53.1 % , respectively ( p < 0.05 ) . Conclusions This study demonstrates that in a carefully selected group of patients , LVBG is significantly more effective than LASGB in terms of late complications , late reoperations , and long-term results on weight loss AIM To evaluate the cost-effectiveness of laparoscopic adjustable gastric b and ing ( LAGB ) versus st and ard medical management ( SMM ) in obese patients with type 2 diabetes from a UK healthcare payer perspective . METHODS A vali date d computer model of diabetes was used to project outcomes reported from a r and omized clinical trial of LAGB versus SMM in obese patients with type 2 diabetes . Two-year follow-up data from the trial were projected over a 40-year time horizon and cost-effectiveness was assessed from the perspective of the National Health Service . Future costs and clinical outcomes were discounted at 3.5 % annually and all costs were reported in 2010 pounds sterling . A series of sensitivity analyses were performed . RESULTS LAGB was associated with benefits in HbA1c , systolic blood pressure , body mass index and serum lipid concentrations , which led to significant increases in discounted life expectancy ( an increase of 0.64 years ) and quality -adjusted life expectancy ( an increase of 0.92 quality -adjusted life years , QALYs ) and reduced incidence of diabetes complications relative to SMM . Treatment costs in the LAGB arm increased by 4552 Great British Pounds ( GBP ) , but this was partially offset by cost savings result ing from a reduction in the incidence of all modelled diabetes complications . The incremental cost-effectiveness ratio of GBP 3602 per QALY in the base case fell well below commonly quoted willingness-to-pay thresholds in the UK setting . CONCLUSIONS On the basis of data from a recent r and omized controlled trial , LAGB is likely to be considered cost-effective from the healthcare payer perspective when compared with SMM of obesity in patients with type 2 diabetes in the UK setting CONTEXT Adolescent obesity is a common and serious health problem affecting more than 5 million young people in the United States alone . Bariatric surgery is being evaluated as a possible treatment option . Laparoscopic adjustable gastric b and ing ( gastric b and ing ) has the potential to provide a safe and effective treatment . OBJECTIVE To compare the outcomes of gastric b and ing with an optimal lifestyle program on adolescent obesity . DESIGN , SETTING , AND PATIENTS A prospect i ve , r and omized controlled trial of 50 adolescents between 14 and 18 years with a body mass index ( BMI ) higher than 35 , recruited from the Melbourne , Australia , community , assigned either to a supervised lifestyle intervention or to undergo gastric b and ing , and followed up for 2 years . The study was performed between May 2005 and September 2008 . MAIN OUTCOME MEASURES Weight loss . Secondary outcomes included change in metabolic syndrome , insulin resistance , quality of life , and adverse outcomes . RESULTS Twenty-four of 25 patients in the gastric b and ing group and 18 of 25 in lifestyle group completed the study . Twenty-one ( 84 % ) in the gastric b and ing and 3 ( 12 % ) in the lifestyle groups lost more than 50 % of excess weight , corrected for age . Overall , the mean changes in the gastric b and ing group were a weight loss of 34.6 kg ( 95 % CI , 30.2 - 39.0 ) , representing an excess weight loss of 78.8 % ( 95 % CI , 66.6%-91.0 % ) , 12.7 BMI units ( 95 % CI , 11.3 - 14.2 ) , and a BMI z score change from 2.39 ( 95 % CI , 2.05 - 2.73 ) to 1.32 ( 95 % CI , 0.98 - 1.66 ) . The mean losses in the lifestyle group were 3.0 kg ( 95 % CI , 2.1 - 8.1 ) , representing excess weight loss of 13.2 % ( 95 % CI , 2.6%-21.0 % ) , 1.3 BMI units ( 95 % CI , 0.4 - 2.9 ) , and a BMI z score change from 2.41 ( 95 % CI , 2.21 - 2.66 ) to 2.26 ( 95 % CI , 1.91 - 2.43 ) . At entry , 9 participants ( 36 % ) in the gastric b and ing group and 10 ( 40 % ) in the lifestyle group had the metabolic syndrome . At 24 months , none of the gastric b and ing group had the metabolic syndrome ( P = .008 ; McNemar chi(2 ) ) compared with 4 of the 18 completers ( 22 % ) in the lifestyle group ( P = .13 ) . The gastric b and ing group experienced improved quality of life with no perioperative adverse events . However , 8 operations ( 33 % ) were required in 7 patients for revisional procedures either for proximal pouch dilatation or tubing injury during follow-up . CONCLUSIONS Among obese adolescent participants , use of gastric b and ing compared with lifestyle intervention result ed in a greater percentage achieving a loss of 50 % of excess weight , corrected for age . There were associated benefits to health and quality of life . TRIAL REGISTRATION ANZCTR Identifier : 12605000160639 The long‐term results of Roux‐en‐$\hbox{Y}$ gastric bypass ( gastric bypass ) and vertical b and ed gastroplasty ( VBG ) from r and omized studies have not been described in detail Laparoscopic Roux‐en‐$\font\ss = cmss10 scaled 1000 \hbox{Y}$ gastric bypass ( LRYGB ) and laparoscopic biliopancreatic diversion with duodenal switch ( LDS ) are surgical options for superobesity . A r and omized trial was conducted to evaluate perioperative ( 30‐day ) safety and 1‐year results BACKGROUND Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  leads to significant weight loss and correction of co-morbidities in most patients .  B and ed LRYGB was design ed to enhance weight loss and avoid weight regain . METHODS A r and omized controlled pilot trial was design ed to comparatively analyze the results and complications of  b and ed ( 6.5 cm ) and unb and ed LRYGB . The present study was an interim analysis focused on morbidity , mortality , and maximal weight loss . RESULTS The 60 patients were divided into 2 groups . Group 1 underwent unb and ed LRYGB ( n = 30 ) and group 2 underwent b and ed LRYGB ( n = 30 ) . No differences were found between the 2 groups in terms of age , gender , body mass index , or operative time . No significant differences were found in the percentage of excess weight loss and body mass index at 6 , 12 , and 24 months between the 2 groups . The frequency of complications was similar in both groups ; 1 patient required b and removal because of stenosis at the level of the mesh . CONCLUSION The weight loss pattern in both groups was similar at 1 and 2 years postoperatively . Proper assessment of weight maintenance and late weight regain will require longer follow-up BACKGROUND Roux-en-Y gastric bypass and biliopancreatic diversion can markedly ameliorate diabetes in morbidly obese patients , often result ing in disease remission . Prospect i ve , r and omized trials comparing these procedures with medical therapy for the treatment of diabetes are needed . METHODS In this single-center , nonblinded , r and omized , controlled trial , 60 patients between the ages of 30 and 60 years with a body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) of 35 or more , a history of at least 5 years of diabetes , and a glycated hemoglobin level of 7.0 % or more were r and omly assigned to receive conventional medical therapy or undergo either gastric bypass or biliopancreatic diversion . The primary end point was the rate of diabetes remission at 2 years ( defined as a fasting glucose level of < 100 mg per deciliter [ 5.6 mmol per liter ] and a glycated hemoglobin level of < 6.5 % in the absence of pharmacologic therapy ) . RESULTS At 2 years , diabetes remission had occurred in no patients in the medical-therapy group versus 75 % in the gastric-bypass group and 95 % in the biliopancreatic-diversion group ( P<0.001 for both comparisons ) . Age , sex , baseline BMI , duration of diabetes , and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months . At 2 years , the average baseline glycated hemoglobin level ( 8.65±1.45 % ) had decreased in all groups , but patients in the two surgical groups had the greatest degree of improvement ( average glycated hemoglobin levels , 7.69±0.57 % in the medical-therapy group , 6.35±1.42 % in the gastric-bypass group , and 4.95±0.49 % in the biliopancreatic-diversion group ) . CONCLUSIONS In severely obese patients with type 2 diabetes , bariatric surgery result ed in better glucose control  than did medical therapy . Preoperative BMI and weight loss did not predict the improvement in hyperglycemia after these procedures . ( Funded by Catholic University of Rome ; Clinical Trials.gov number , NCT00888836 . ) BACKGROUND Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery . METHODS In this r and omized , nonblinded , single-center trial , we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes . The mean ( ±SD ) age of the patients was 49±8 years , and 66 % were women . The average  glycated hemoglobin level was 9.2±1.5 % . The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0 % or less 12 months after treatment . RESULTS Of the 150 patients , 93 % completed 12 months of follow-up . The proportion of patients with the primary end point was 12 % ( 5 of 41 patients ) in the medical-therapy group versus 42 % ( 21 of 50 patients ) in the gastric-bypass group ( P=0.002 ) and 37 % ( 18 of 49 patients ) in the sleeve-gastrectomy group ( P=0.008 ) . Glycemic control improved in all three groups , with a mean glycated hemoglobin level of 7.5±1.8 % in the medical-therapy group , 6.4±0.9 % in the gastric-bypass group ( P<0.001 ) , and 6.6±1.0 % in the sleeve-gastrectomy group ( P=0.003 ) . Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group ( -29.4±9.0 kg and -25.1±8.5 kg , respectively ) than in the medical-therapy group ( -5.4±8.0 kg ) ( P<0.001 for both comparisons ) . The use of drugs to lower glucose , lipid , and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) improved significantly after bariatric surgery . Four patients underwent reoperation . There were no deaths or life-threatening complications . CONCLUSIONS In obese patients with uncontrolled type 2 diabetes , 12 months of medical therapy plus bariatric surgery  achieved glycemic control in significantly more patients than medical therapy alone . Further study will be necessary to assess the durability of these results . ( Funded by Ethicon Endo-Surgery and others ; Clinical Trials.gov number , NCT00432809 . ) BACKGROUND Obesity is a risk factor for cancer . Intentional weight loss in the obese might protect against malignancy , but evidence is limited . To our knowledge , the Swedish Obese Subjects ( SOS ) study is the first intervention trial in the obese population to provide prospect i ve , controlled cancer-incidence data . METHODS The SOS study started in 1987 and involved 2010 obese patients ( body-mass index [ BMI ] > or=34 kg/m(2 ) in men , and > or=38 kg/m(2 ) in women ) who underwent bariatric surgery and 2037 contemporaneously matched obese controls , who received conventional treatment .  While the main endpoint of SOS was overall mortality , the main outcome of this exploratory report was cancer incidence until Dec 31 , 2005 . Cancer  follow-up rate was 99.9 % and the median follow-up time was 10.9 years ( range 0 - 18.1 years ) . FINDINGS Bariatric surgery result ed in a sustained mean weight reduction of 19.9 kg ( SD 15.6 kg ) over 10 years , whereas the mean weight change in controls was a gain of 1.3 kg ( SD 13.7 kg ) . The number of first-time cancers after inclusion was lower in the surgery group ( n=117 ) than in the control group ( n=169 ; HR 0.67 , 95 % CI 0.53 - 0.85 , p=0.0009 ) . The sex-treatment interaction p value was 0.054 . In women , the number of first-time cancers after inclusion was lower in the surgery group ( n=79 ) than in the control group ( n=130 ; HR 0.58 , 0.44 - 0.77 ; p=0.0001 ) , whereas there was no effect of surgery in men ( 38 in the surgery group vs 39 in the control group ; HR 0.97 , 0.62 - 1.52 ; p=0.90 ) . Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention . INTERPRETATION Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men . FUNDING Swedish Research Council , Swedish Foundation for Strategic Research , Swedish Federal Government under the LUA/ALF agreement , Hoffmann La Roche , Cederoths , AstraZeneca , Sanofi-Aventis , Ethicon Endosurgery Background The incidence of obesity and related metabolic disorders in India and that of stomach carcinoma is one of the highest in the world . Hence , one requires a procedure that allows postoperative surveillance of the stomach with the best outcomes in terms of weight control and resolution of co-morbidities . Here , we compare one such procedure , duodenojejunal bypass with sleeve against the st and ard Roux-en Y gastric bypass . Methods Fifty-seven patients who were selected for a bypass procedure were r and omized into two groups of laparoscopic duodenojejunal bypass with sleeve ( DJB ) and laparoscopic Roux en Y gastric bypass . The limb lengths were similar in both the groups , and the sleeve was done over a 36F bougie . Results The mean body mass index and percent excess weight loss at the end of 3 , 6 , and 12 months between the groups were not statistically significant . The operating times were higher in the DJB group . The rate of resolution of diabetes , hypertension , and dyslipidemias were also similar with no statistical significance . There was 100 % resolution of dyslipidemias in both groups . There was one patient in the DJB group who presented with internal herniation 1 month post-op and was managed surgically . There was no mortality in both the groups . Conclusion Laparoscopic duodenojejunal with sleeve gastrectomy , a procedure which combines the principles and advantages of sleeve gastrectomy and foregut hypothesis , is a safe and effective alternative to gastric bypass in weight reduction and resolution of co-morbidities especially for Asian countries . But , long-term follow-up is required
target: Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions , regardless of the type of procedures used .
  When compared with each other , certain procedures result ed in greater weight loss and improvements in comorbidities than others .
  Outcomes were similar between RYGB and sleeve gastrectomy , and both of these procedures had better outcomes than adjustable gastric b and ing .
  For people with very high BMI , biliopancreatic diversion with duodenal switch result ed in greater weight loss than RYGB .
  Isolated sleeve gastrectomy led to better weight-loss outcomes than adjustable gastric b and ing after three years follow-up .
background: BACKGROUND Bariatric ( weight loss ) surgery for obesity is considered when other treatments have failed .
  The effects of the available bariatric procedures compared with medical management and with each other are uncertain .
  This is an up date of a Cochrane review first published in 2003 and most recently up date d in 2009 .
  OBJECTIVES To assess the effects of bariatric surgery for overweight and obesity , including the control of comorbidities .