title: Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Fourteen-Year Long-Term Results after Gastric Banding Effects of bariatric surgery on mortality in Swedish obese subjects. 10-year Follow-up of Laparoscopic Vertical Banded Gastroplasty: Good Results in Selected Patients Graft Survival and Complications after Laparoscopic Gastric Banding for Morbid Obesity—Lessons Learned from a 12-Year Experience 15-year follow-up of vertical banded gastroplasty: comparison with other restrictive procedures Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult‐Onset Diabetes Mellitus Weight Loss Outcome After Roux-en-Y Gastric Bypass: 10 Years of Follow-up 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 Vertical banded gastroplasty versus adjustable gastric banding: prospective long-term follow-up study. A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways Erosions After Laparoscopic Adjustable Gastric Banding: Diagnosis and Management Vertical Banded Gastroplasty vs Gastric Bypass: 10 Years follow-up Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Long-term outcome of laparoscopic adjustable gastric banding (LAGB): results of a Swiss single-center study of 405 patients with up to 18 years' follow-up. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial Laparoscopic adjustable gastric banding: efficacy and consequences over a 13-year period. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5‐Year Outcomes Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass.
abstract: Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass ( 60.4 % ) than after sleeve gastrectomy ( 25.0 % ) . Gastric reflux worsened ( more symptoms or increase in therapy ) more often after sleeve gastrectomy ( 31.8 % ) than after Roux-en-Y gastric bypass ( 6.3 % ) . The number of patients with reoperations or interventions was 16/101 ( 15.8 % ) after sleeve gastrectomy and 23/104 ( 22.1 % ) after Roux-en-Y gastric bypass . Conclusions and Relevance Among patients with morbid obesity , there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery . Trial Registration clinical trials.gov Identifier : 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 For over a decade , the laparoscopic adjustable gastric b and ( LAGB ) was 1 of the most performed bariatric procedures in Europe . This study is a retrospective analysis with prospect ively collected data of the experience in 1 specialized Dutch center with the adjustable gastric b and over 14 years . METHODS Between 1995 and 2003 , 201 patients underwent an LAGB for morbid obesity in our hospital . Data on preoperative clinical characteristic , postoperative outcome and weight loss patterns , and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System ( BAROS ) . RESULTS Average follow-up was 13.6 ( ± 2.0 ) years ( 163 mo ) and 99 % of patients with complete follow-up . Two thirds of patients reached an excess weight loss (EWL)>50 % at some point after LAGB placement . However , due to insufficient weight loss or complications in 53 % of patients , the LAGB had to be removed or converted to a Roux-en-Y gastric bypass . Additionally , half of the remaining patients had disappointing results according to the BAROS score . In total , less than one quarter ( 22 % ) of patients had a functioning b and with a good result after the follow-up period . Although initially the number of patients experiencing co-morbidities was reduced , most of them returned and a large number of patients developed new co-morbidities . Complications , other than weight regain , were numerous as 47 % of patients experienced at least 1 . In total , 204 reoperations were performed in 137 ( 68 % ) patients . Furthermore , patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up . CONCLUSION Morbid obesity is a chronic disease that can be resolved with bariatric surgery . One of the treatment options is the LAGB , which in the short term shows good results in terms of EWL and co-morbidity reduction . In the long term , however , EWL and co-morbidity reduction are disappointing , and the LAGB does not seem to live up to expectations . Besides the decrease in EWL over time , the number of reoperations required is alarming . In total , less than a quarter of patients still had a functioning b and after a mean 14 years of follow-up Background . Gastric b and ing ( GB ) is a common bariatric procedure that is performed worldwide . Weight loss can be substantial after this procedure , but it is not sufficient in a significant portion of patients . Long-term rates for associated complications increase with every year of follow up , and only a few long-term studies have been published that examine these rates . We present our results after 14 years of postoperative follow up . Methods . Two hundred patients were operated upon form 01.02.1995 to 31.01.2009 . Data collection was performed prospect ively . In retrospective analysis , we analyzed weight loss , short- and long-term complications , amelioration of comorbidities and long-term outcome . Results . The mean postoperative follow up time was 94.4 months ( range 2–144 ) . The follow up rate was 83.5 % . The incidence of postoperative complications for slippage was 2.5 % , for pouch dilatation was 9.5 % , for b and migration was 5.5 % and 12.0 % for overall b and removal . After 14 years , the reoperation rate was 30.5 % with a reoperation rate of 2.2 % for every year of follow up . Excess weight loss was 40.2 % after 1 year , 46.3 % after 2 years , 45.9 % after 3 years , 41.9 % after five years , 33.3 % after 8 years , 30.8 % after 10 years , 33.3 % after 12 years and 15.6 % after 14 years of follow up . Conclusion . The complication and reoperation rate after GB is high . Nevertheless , GB is still a therapeutic option in morbid obese patients , but the criteria for patient selection should be carefully evaluated BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Objective : To evaluate the long-term results of laparoscopic vertical b and ed gastroplasty ( VBG )  for morbid obesity . Background : Laparoscopic VBG , a safe and straightforward bariatric procedure characterized by good short-term results , has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure . Nevertheless , some authors have recently reported long-term efficacy in selected patients . Methods : All patients who underwent laparoscopic VBG  were included in a prospect i ve data base . Patients reaching 10-year follow-up received a complete evaluation including clinical , endoscopic , and biochemical examinations . Results : Between January 1996 and March 1999 , 266 morbidly obese patients underwent bariatric procedures . Among them , 213 were selected for laparoscopic VBG ; exclusion criteria were as follows : contraindications to pneumoperitoneum , gastroesophageal reflux disease , and psychological contraindications to restrictive procedures . Mean age , preoperative weight , and body mass index were 36.9 years , 123.6 kg , and 45.4 kg/m2 , respectively .  Intraoperative complication rate and conversion rate were 0.9 % and 0.9 % , respectively . Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 % . Mean hospital length of stay was 6.3 days . Mortality was nil . The 10-year follow-up rate was 70.4 % ( 150 patients ) . Late postoperative complication rate was 14.7 % , and 10-year revisional surgery rate was 10.0 % . The excess weight loss percentages at 3 , 5 , and 10 years were 65.0 % , 59.9 % , and 59.8 % , respectively . The resolution and /or improvement rate for comorbidity were 47.5 % for hypertension , 55.6 % for diabetes , 75 % for sleep apnea , and 47.4 % for arthritis . Mean Moorehead-Ardelt Quality of Life Question naire and BAROS values were 1.4 and 3.8 , respectively . Conclusions : The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures . Given the low postoperative morbidity for laparoscopic VBG , its present clinical role should be , in our opinion , reevaluated Laparoscopic adjustable gastric b and ing ( LAGB ) has been considered by many as the treatment of choice for morbid obesity because of its simplicity and encouraging early results . The aim of this prospect i ve study was to critically assess the effects , complications , and outcome after LAGB in the long-term , based on a 12-year experience . Between June 1998 and June 2009 , all patients with implantation of a LAGB  have been enrolled in a prospect i ve clinical trial . Results were recorded and classified , with special regard to long-term complications , re-operation rate , and graft survival .  LAGB was performed in 167 patients ( 120 female , 47 male ) with a mean age of 40.1 ± 5.2 years . Operative mortality was 0 % , overall 1.2 % ( not b and -related ) . Overall patient follow-up was 94.0 % . Mean excess weight loss ( EWL ) after 1 , 2 , 5 , 8 , and 10 years was 31.1 ± 7.5 % ( p < 0.005 ) , 44.2 ± 6.5 % ( p < 0.001 ) , 50.3 ± 6.9 % ( p < 0.001 ) , 51.7 ± 6.3 % ( p < 0.001 ) , and 48.8 ± 6.0 % ( p < 0.001 ) , respectively . The non-responder rate ( EWL < 30 % ) after 2 , 5 , 8 , and 10 years was 24.5 % , 18.3 % , 12.5 % , and 16.6 % , respectively . The early complication rate ( < 30 days ) was 7.8 % ( 13/167 ) , with 10 minor and three major complications . Late complications ( > 30 days ) occurred in 40.1 % ( 67/167 ) , of whom seven were minor and 60 were major complications ( three b and infections , two b and migrations , 11 b and leakages , two slippings/pouch dilatations , two b and intolerances , and 40 esophageal dilatations ) . The overall re-operation rate was 20.4 % ( 34/167 ) . The graft survival of the implanted b and after 2 , 5 , 8 , 10 , and 12 years was 98.8 % , 94.0 % , 86.8 % , 85.0 % , and 85.0 % , respectively . The failure rate of the procedure after 2 , 5 , 8 , and 10 years was 25.7 % , 24.3 % , 25.7 % , and 31.6 % , respectively . In the present long-term high-participation follow-up study ,  LAGB  is a safe and effective surgical treatment for morbid obesity . However , the high complication , re-operation , and long-term failure rates lead to the conclusion that LAGB should be performed in selected cases only , until reliable criteria for patients at low risk for long-term complications are developed Abstract Introduction Vertical b and ed gastroplasty ( VBG ) has been the procedure of choice for bariatric surgeries since the 1980s . However , long-term results of VBG have been reported with different opinions , and new restrictive procedures have been innovated and showing variable results . The aim of this study is to analyze the long-term results of our VBG patients .Patient and methods Between June 1998 and May 2002 , 652 morbidly obese patients received VBG , with the initial 40 patients having open procedures and the subsequent 612 patients using a laparoscopic approach .  Operative complications , weight loss , and late complications were followed and compared with groups of laparoscopic adjustable gastric b and ing ( LAGB ) and sleeve gastrectomy ( LSG ) . Results Mean age , preoperative weight , and body mass index ( BMI ) were 30.96 years , 108.83 kg , and 40.63 kg/m2 , respectively . The overall early postoperative complication rate was 3.4 % ( 22/652 ) . The excess weight loss percentages at 1 , 2 , 5 , and 10 years were 61.04 , 59.70 , 51.11 , and 42.0 % , respectively . BMI at 1 , 2 , 5 , and 10 years were 29.64 , 29.71 , 31.33 , and 31.73 kg/m2 , respectively . This result is inferior to the 67 % excess weight loss in the LSG group , but is higher than the 38 % excess weight loss of the LAGB group . The revision rate is 13.19 % ( 86/652 ) up to now . Revision surgery was required in 28 ( 14.0 % ) patients in the LAGB group and 8 ( 1.3 % ) in the LSG group . Conclusion VBG was an operation with acceptable outcome for treating morbid obesity and metabolic disorders . It sets a st and ard for new restrictive procedures BACKGROUND The short-term benefits of bariatric surgery are well documented ; however , few reports with data beyond 10 years exist . Those that have been published have described only open procedures . We present our 10-year follow-up results with  laparoscopic Roux-en-Y gastric bypass with h and -sewn gastrojejunal anastomosis in a group private practice . METHODS We performed an institutional review board-approved retrospective review of a prospect ively maintained data base , combined with office visits and telephone question naires , for patients who underwent laparoscopic Roux-en-Y gastric bypass between February 1998 and April 1999 . RESULTS A total of 242 patients underwent surgery from February 1998 to April 1999 . The office follow-up rate was 33 % at 2 years and 7 % at 10 years . An additional 19 % had telephone follow-up at 10 years . The mean excess weight loss was 57 % at 10 years . Of the 242 patients , 65 ( 33.2 % ) failed to achieve an excess weight loss of > 50 % ; 86 ( 35 % ) had ≥1 complication during follow-up . However , 83 % , 87 % , 67 % , and 76 % of patients with diabetes , hypertension , dyslipidemia , and obstructive sleep apnea , respectively , experienced improvement or resolution . The internal hernia rate was 16 % , and the gastrojejunal stenosis rate was 4.9 % . No surgery-related deaths occurred . Of the 242 patients , 136 ( 51 % ) had nutritional testing at least once after postoperative year 1 . Of these 136 patients , only 24 ( 18 % ) had remained nutritionally intact during follow-up . CONCLUSION The obstacles to follow-up have continued to impede the collection of accurate long-term data . Of the 26 % of patients with data , laparoscopic Roux-en-Y gastric bypass provided sustainable weight loss and resolution of co-morbidities . However , nutritional deficiencies presented sporadically over time and underscore the importance of routine testing Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Background By su bmi tting obese people to surgical treatment , we hope they lose weight and stay slim . Long-term monitoring is essential to assess effectiveness of surgery . This study aims to evaluate weight loss over 10 years in an obese population undergoing b and ed Roux-en-Y gastric bypass ( B-RYGBP ) .  Methods The surgery was performed in 211 obese between May 1999 and December 2000 . This prospect i ve study evaluated excess weight loss ( % EWL ) and body mass index ( BMI ) during the period . We considered surgical treatment failure if % EWL was less than 50 % . Results We followed 54.9 % of the population ( 116 patients ) .  Patients ' % EWL was 67.6 ± 14.9 % 1 year after surgery , 72.6 ± 14.9 % after 2 years , 69.7 ± 15.1 % after 5 years , 66.8 ± 7.6 % after 8 years , and 67.1 ± 11.9 % after 10 years postoperatively . Surgical treatment failure occurred in 16 patients ( 14.6 % ) over 10 years . Conclusions B-RYGBP is a good technique to promote and maintain weight loss 10 years after surgery with low failure rate 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 Vertical b and ed gastroplasty ( VBG ) has been in clinical use since 1979 and adjustable gastric b and ing ( AGB ) since 1985 . Because promising results were achieved with the adjustable gastric b and s available in the market , some surgeons came to the conclusion that VBG might be entirely ab and oned and replaced by the adjustable gastric b and . The aim of this study was to compare the long-term outcome of the 2 restrictive procedures . METHODS Within a 7-year period ( 1994 - 2001 ) , 1117 gastric restrictive procedures were performed in the course of a prospect i ve nonr and omized comparative trial . We report the outcomes of 563 VBG and 554 AGB procedures performed by 2 surgeons . The mean body mass index was 46.9 + /- 09.9 kg/m(2 ) for VBG and 46.7 + /- 07.8 kg/m(2 ) for AGB . Patient selection was performed by acceptance by 1 of the 2 surgeons . VBG was performed by laparotomy and AGB using laparoscopy . The Bariatric Analysis and Reporting Outcome System ( BAROS ) was used to evaluate the postoperative health status and quality of life . RESULTS The mean duration of follow-up was 92 months ( range 60 - 134 ) , with a minimum of 5 years . The overall follow-up rate was 92 % . In the short-term 3-year follow-up , no statistically significant difference was registered between AGB and VBG in terms of weight loss , reduction of co-morbidities , or improvement in quality of life . The 30-day mortality rate was .4 % ( 2 patients ) for VBG and .2 % ( 1 patient ) for AGB . The overall reintervention rate in the long term was 49.7 % for VBG and 8.6 % for AGB ( P < .0001 , odds ratio .0937 , 95 % confidence interval .065-.133 ) , the reoperation rate was 39.9 % for VBG and 7.5 % for AGB ( P < .0001 ) . The excess weight loss was significantly greater in the VBG group after 12 months ( 58 % for VBG versus 42 % for AGB , P < .05 ) . At long-term follow-up ( mean 92 months ) , no significant difference in weight loss was registered between the 2 study groups ( 59 % for VBG and 62 % for AGB , P = .923 ) . The BAROS score in the short term ( 3 years ) was good to excellent in 94 % and 90 % of the VBG and AGB groups , respectively . In the long-term follow-up period , the BAROS score was significantly in favor of the AGB group ( 83.9 % versus 57.8 % , P < .0001 , odds ratio 3.797 , 95 % confidence interval 2.072 - 7.125 ) . The overall resolution rate of co-morbidities was 80 % in both groups . CONCLUSION This long-term follow-up study shows that VBG and AGB are effective restrictive procedures to achieve weight loss , and loss of co-morbidities . A statistically significant lower re-intervention and re-operation rate and an improved health status and quality of life were registered for AGB Background : Laparoscopic adjustable gastric b and ing ( LAGB ) is a safe and effective method for the treatment of obesity . The most common problem after LAGB has been the occurrence of prolapse ( slippage ) of the stomach through the b and . It has been proposed that the pars flaccida ( PF ) pathway ( dissection from the base of the right crus , along the left crus to the angle of His ) is less likely to be associated with prolapse than the traditional perigastric ( PG ) pathway ( dissection between the lesser curvature of stomach and lesser omentum , across the apex of the lesser sac , to the angle of His ) . We have tested this hypothesis using a r and omized controlled trial format . Methods : We have performed a r and omized controlled trial to compare the outcomes after LAGB using PF and PG pathways .  202 patients ( mean age 40 years , mean weight 123 kg , mean BMI 45 ) were r and omly allocated to the PF or PG pathway and followed for 2 years . Results : At 24 months , there have been 16 revisional procedures for prolapse , 4 in the PF group ( all anterior prolapse ) and 15 in the PG group ( 12 posterior and 3 anterior ) . This difference is significant ( P<0.001 ) . The mean % excess weight lost was 53 % for the PF group and 46 % for the PG group . There was equally significant improvements in the metabolic syndrome in both groups ( 59 % preoperatively and 19 % at 2 years ) . All 8 paired domain scores of the SF-36 measures of quality of life were improved significantly in both group ( P<0.001 ) . Conclusions : The PF pathway is as effective as the PG pathway in generating substantial weight loss , improved health and improved quality of life and is significantly less likely to be associated with prolapse ( slippage ) . It is recommended as the primary dissection pathway Objective : To define the changing prevalence of erosion after  Laparoscopic Adjustable Gastric B and ing ( LAGB ) , describing the range of clinical presentations , the approaches to treatment and the outcomes from these approaches over a 15-year study period . Background : A recent systematic review of the literature of erosion after LAGB identified 25 relevant studies and reported a total of 231 erosions in 15,775 patients giving an overall incidence of 1.46 % . The review highlighted a broad variation of incidence from 0.2 % to 33 % . The review was unable to identify either common presentations or an optimal pattern of management . Methods : Patients who underwent a primary LAGB operation between September 1994 and January 2010 by 2 surgeons ( P.O.B. and W.B. ) were identified in a prospect ively maintained data base . Those patients who had an erosion of their LAGB were identified . Presentation , operative details , demographics , body mass index , weight history , and perioperative problems were analyzed . Results : In total , 2986 patients were identified . All b and s placed were Lap-B and s ( Allergan , CA ) . Hundred erosions were experienced by 85 patients ( 2.85 % ) at a median time of 33 months from initial surgery to the erosion ( range : 11–170 months ) . The rate of erosion was highest when the b and was placed by the perigastric approach at 6.77 % . Since the adoption of the pars flaccida approach , the rate of erosion has dropped to 1.07 % . The majority of patients who had experienced an erosion ( 71 patients ; 83.5 % ) experienced only 1 erosion , 13 patients ( 15.3 % ) had 2 erosions , and 1 patient had 3 erosions . The most common presentation was loss of satiety . The b and has been successfully replaced in 56 patients . It has been explanted in 27 patients and 2 patients were converted to other bariatric procedures . The weight loss in patients who had a LAGB reinserted after erosion was not significantly different to the background cohort . Conclusions : Erosion of LAGB is uncommon and its clinical course is benign . It is best treated with a staged surgical approach ; initially , with removal and repair followed later by replacement . With this approach , weight loss is maintained and reerosion is uncommon In 1982 , a prospect i ve study to evaluate and compare the operations for treatment of morbid obesity , vertical b and ed gastroplasty ( VBG ) and gastric bypass ( GBP ) , was carried out at the Center for Surgical Treatment of Obesity in Los Angeles . The VBG was performed as described by Dr Mason with a 5.0 cm circumference Marlex b and . The GBP was the horizontal GBP with ≤ 50 cc pouch as described by Mason and modified by Printen and Griffen . One hundred patients had the VBG and 100 had the GBP .  At 10 years follow-up , only 43 of the VBG patients and 46 of the GBP patients can be found . The groups are compared as to the perioperative complications , late complications and weight loss .  VBG compared favorably with GBP for control of morbid obesity .  GBP  yields better weight loss and maintenance at all times of follow-up . Both procedures are equal in terms of morbidity and mortality BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND In the past , laparoscopic adjustable gastric b and ing ( LAGB ) seemed to be a promising bariatric procedure . However , many studies showed high rates of reoperation due to complications or insufficient weight loss . There is a lack of long-term studies with follow-up beyond 15 years . OBJECTIVE To conduct long-term follow-up of patients after LAGB and analyze their weight loss as a primary endpoint . SETTING Tertiary referral center for bariatric surgery , St. Claraspital , Switzerl and . METHODS A retrospective analysis of prospect ively collected clinical data in a cohort of 405 patients having undergone LAGB  was performed . RESULTS A total of 405 patients ( age 41±10 years , body mass index [ BMI ] 44.3±6 kg/m2 ) were treated with LAGB between 1996 and 2010 . Mean follow-up was 13±3 years , with a follow-up rate of 85 % ( range 8 - 18 years ) , corresponding to 343 patients . One hundred patients exceeded 15-year follow-up . In 216 patients ( 63 % ) , sleeve gastrectomy , gastric bypass , or biliopancreatic diversion with duodenal switch was performed as revisional surgery . Twenty-seven patients ( 8 % ) refused revisional surgery after b and removal . Finally , 100 patients ( 29 % ) still have the b and in place , with a mean BMI of 35±7 kg/m2 , corresponding to an excess BMI loss of 48±27 % . Among these , the failure rate was 25 % , according to the Bariatric Analysis and Reporting Outcome System ( BAROS ) ; 50 % had a good to excellent outcome . CONCLUSION More than 10 years after LAGB , 71 % of patients lost their b and s and only 15 % of the 343 followed patients with the b and in place have a good to excellent result , according to BAROS Importance Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass . Objective To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity . Design , Setting , and Participants The Sleeve vs Bypass ( SLEEVEPASS ) multicenter , multisurgeon , open-label , r and omized clinical equivalence trial was conducted from March 2008 until June 2010 in Finl and . The trial enrolled 240 morbidly obese patients aged 18 to 60 years , who were r and omly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period ( last follow-up , October 14 , 2015 ) . Interventions Laparoscopic sleeve gastrectomy ( n = 121 ) or laparoscopic Roux-en-Y gastric bypass ( n = 119 ) . Main Outcomes and Measures The primary end point was weight loss evaluated by percentage excess weight loss . Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were −9 % to + 9 % excess weight loss . Secondary end points included resolution of comorbidities , improvement of quality of life ( QOL ) , all adverse events ( overall morbidity ) , and mortality . Results Among 240 patients r and omized ( mean age , 48 [ SD , 9 ] years ; mean baseline body mass index , 45.9 , [ SD , 6.0 ] ; 69.6 % women ) , 80.4 % completed the 5-year follow-up . At baseline , 42.1 % had type 2 diabetes , 34.6 % dyslipidemia , and 70.8 % hypertension . The estimated mean percentage excess weight loss at 5 years was 49 % ( 95 % CI , 45%-52 % ) after sleeve gastrectomy and 57 % ( 95 % CI , 53%-61 % ) after gastric bypass ( difference , 8.2 percentage units [ 95 % CI , 3.2%-13.2 % ] , higher in the gastric bypass group ) and did not meet criteria for equivalence . Complete or partial remission of type 2 diabetes was seen in 37 % ( n = 15/41 ) after sleeve gastrectomy and in 45 % ( n = 18/40 ) after gastric bypass ( P > .99 ) . Medication for dyslipidemia was discontinued in 47 % ( n = 14/30 ) after sleeve gastrectomy and 60 % ( n = 24/40 ) after gastric bypass ( P = .15 ) and for hypertension in 29 % ( n = 20/68 ) and 51 % ( n = 37/73 ) ( P = .02 ) , respectively . There was no statistically significant difference in QOL between groups ( P = .85 ) and no treatment-related mortality . At 5 years the overall morbidity rate was 19 % ( n = 23 ) for sleeve gastrectomy and 26 % ( n = 31 ) for gastric bypass ( P = .19 ) . Conclusions and Relevance Among patients with morbid obesity , use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years . Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years , the difference was not statistically significant , based on the prespecified equivalence margins . Trial Registration clinical trials.gov Identifier : BACKGROUND Laparoscopic adjustable gastric b and ing ( LAGB ) is a common bariatric surgery . Although it is a safe and effective method of weight reduction in short term , it may result in some problems in long term . The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients . METHODS In this prospect i ve study , 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006 . Long-term postoperative consequences and complications of these patients were recorded . RESULTS The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2 ) , respectively . Over the 13-year follow-up period , 56 patients ( 84.8 % ) experienced at least one complication . The most common complications were b and erosion ( 20 patients ) and weight regains ( 13 patients ) . Fifty-one patients ( 78.5 % ) required reoperation . The b and of 48 patients ( 72.7 % ) was removed ; of these , twenty patients ( 30.3 % ) underwent other bariatric surgeries . Percent of excess weight loss was 47.1 % ± 30.1 % , and the success rate was 48.7 % . CONCLUSIONS LAGB is a successful method with low complications in short term ; however , over long term , it results in various complications BACKGROUND Long‐term results from r and omized , controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited . METHODS We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body‐mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) of 27 to 43 were r and omly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux‐en‐Y gastric bypass or sleeve gastrectomy . The primary outcome was a glycated hemoglobin level of 6.0 % or less with or without the use of diabetes medications . RESULTS Of the 150 patients who underwent r and omization , 1 patient died during the 5‐year follow‐up period ; 134 of the remaining 149 patients ( 90 % ) completed 5 years of follow‐up . At baseline , the mean ( ±SD ) age of the 134 patients was 49±8 years , 66 % were women , the mean glycated hemoglobin level was 9.2±1.5 % , and the mean BMI was 37±3.5 . At 5 years , the criterion for the primary end point was met by 2 of 38 patients ( 5 % ) who received medical therapy alone , as compared with 14 of 49 patients ( 29 % ) who underwent gastric bypass ( unadjusted P=0.01 , adjusted P=0.03 , P=0.08 in the intention‐to‐treat analysis ) and 11 of 47 patients ( 23 % ) who underwent sleeve gastrectomy ( unadjusted P=0.03 , adjusted P=0.07 , P=0.17 in the intention‐to‐treat analysis ) . Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone ( 2.1 % vs. 0.3 % , P=0.003 ) . At 5 years , changes from baseline observed in the gastric‐bypass and sleeve‐gastrectomy groups were superior to the changes seen in the medical‐therapy group with respect to body weight ( ‐23 % , ‐19 % , and ‐5 % in the gastric‐bypass , sleeve‐gastrectomy , and medical‐therapy groups , respectively ) , triglyceride level ( ‐40 % , ‐29 % , and ‐8 % ) , high‐density lipoprotein cholesterol level ( 32 % , 30 % , and 7 % ) , use of insulin ( ‐35 % , ‐34 % , and ‐13 % ) , and quality ‐of‐life measures ( general health score increases of 17 , 16 , and 0.3 ; scores on the R AND 36‐Item Health Survey ranged from 0 to 100 , with higher scores indicating better health ) ( P<0.05 for all comparisons ) . No major late surgical complications were reported except for one reoperation . CONCLUSIONS Five‐year outcome data showed that , among patients with type 2 diabetes and a BMI of 27 to 43  , bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing , or in some cases resolving , hyperglycemia . ( Funded by Ethicon Endo‐Surgery and others ; STAMPEDE Clinical Trials.gov number , NCT00432809 . BACKGROUND  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  has been the " gold st and ard " for weight loss surgery . Long-term data are limited , and reporting methods for LRYGB outcomes vary in the literature . In addition , follow-up compliance within bariatric centers is poor due to insurance and access to care issues , making long-term follow-up evaluation difficult . OBJECTIVE Evaluate long-term LRYGB outcomes using st and ard outcome reporting definitions . SETTING Integrated multispecialty health system . METHODS A retrospective review of our institution 's prospect i ve bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015 . Data were defined according to the 2015 St and ards for Outcome Reporting . RESULTS During the study period , 1402 patients underwent primary LRYGB ; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2 , respectively . Early complications included anastomotic leak ( 0.2 % ) , venous thromboembolism ( 0.6 % ) , surgical site infections ( 1.4 % ) , and urinary tract infections ( 1.6 % ) . The 30-day readmission rate was 3.5 % . There were no 30-day mortalities . Follow-up weight data were available for>70 % of eligible patients through 12 years postoperative . The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79 % and 30.1 kg/m2 , respectively . Remission of diabetes , dyslipidemia , and hypertension were observed through 8 years postoperatively . CONCLUSION This is the first report of long-term ( > 10-year ) outcomes from a single integrated health system using the 2015 St and ards for Outcome Reporting . LRYGB results in significant , sustained weight loss and durable improvement and remission of obesity-related co-morbidities . Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up
target: Reoperations were common in all groups .
  Reoperation rate was initially high but reduced markedly with improved b and and surgical and aftercare techniques .
  Conclusion All current procedures are associated with substantial and durable weight loss .
  More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy  .
  Reoperation is likely to remain common across all procedures
background: Introduction Durability is a key requirement for the broad acceptance of bariatric surgery .