title: Laparoscopic Adjustable Gastric Banding versus Open Vertical Banded Gastroplasty: A Prospective Randomized Trial Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass in US Veterans How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Effects of bariatric surgery on mortality in Swedish obese subjects. Gastric Surgery for Morbid Obesity: The Adelaide Study A Prospective Comparison of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass in a Non-Superobese Population Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult‐Onset Diabetes Mellitus A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways 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 Long-Term Results of a Prospective Study on Laparoscopic Adjustable Gastric Banding for Morbid Obesity Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction. Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding. Laparoscopic Gastric Banding: A Prospective, Randomized Study Comparing the Lapband and the SAGB: Early Results Laparoscopic Sleeve Gastrectomy — Influence of Sleeve Size and Resected Gastric Volume Health benefits of gastric bypass surgery after 6 years. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. A comparison of observational studies and randomized, controlled trials Health‐related quality of life after gastric banding A 10-year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass Loss to Follow-Up in Cohort Studies: How Much is Too Much? Safety and effectiveness of Realize adjustable gastric band: 3-year prospective study in the United States. Perioperative safety in the longitudinal assessment of bariatric surgery.
abstract: Background : Laparoscopic adjustable gastric b and ing ( LAGB ) and open vertical b and ed gastroplasty ( VBG ) are treatment modalities for morbid obesity . However , few prospect i ve r and omized clinical trials ( RCT ) have been performed to compare both operations . Methods : 100 patients ( 50 per group ) were included in the study . Postoperative outcomes included hospital length of stay ( LOS ) , complications , percent excess weight loss ( % EWL ) , BMI and reduction in total comorbidities . Follow-up in all patients was 2 years . Results : LOS was significantly shorter in the LAGB group . 3 LAGB were converted to open ( 1 to gastric bypass ) . Directly after VBG , 3 patients needed relaparotomies due to leakage , of which one ( 2 % ) died . After 2 years , 100 % follow-up was achieved . BMI and % EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group ( 31.0 kg/m2 and 70.1 % vs 34.6 and 54.9 % respectively ) . Co-morbidities significantly decreased in both groups in time . 2 years after LAGB , 20 patients needed reoperation for pouch dilation/slippage ( n=12 ) , b and leakage ( n=2 ) , b and erosion ( n=2 ) and access-port problems ( n=4 ) . In the VBG group , 18 patients needed revisional surgery due to staple-line disruption ( n=15 ) , narrow outlet ( n=2 ) or insufficient weight loss ( n=1 ) . Furthermore , 8 VBG patients developed an incisional hernia . Conclusion : This RCT demonstrates that , despite the initial better weight loss in the  VBG group , based on complication rates and clinical outcome , LAGB is preferred . It had a shorter LOS and less postoperative morbidity Background The objective of this study is to evaluate the long-term outcomes following  laparoscopic Roux-en-Y gastric bypass ( LREYGB ) in veteran patients . The VA bariatric population differs from its counterpart in the private sector by the predominance of a male population , a higher percentage of patients from a lower socioeconomic background , a higher mean age , and a higher rate of obesity-related comorbidities . Methods A retrospective review with prospect ively collected data was used to analyze postoperative changes of comorbidities and percent of excess weight loss ( % EWL ) in consecutive patients who underwent LREYGB between August 2003 and September 2006 . Results Among 70 patients , 73 % were men with a mean age of 52 years ( 29–66 years ) . Average preoperative weight and body mass index were 310 lbs ( 224–397 lbs ) and 46 kg/m2 ( 36–60 kg/m2 ) , respectively . The incidence of major and minor complications was 1.4 % and 15.7 % , respectively . There were no mortalities . Follow-up ( f/u ) was possible in all patients . At a mean f/u rate of 39 months , % EWL was 56 % . At 1 , 3 , and 5 years , % EWL was 61 % , 53 % , and 59 % , respectively . Thirty-five patients ( 50 % ) had type 2 diabetes mellitus ( T2DM ) . Glycosylated hemoglobin concentrations returned to normal levels in 91 % of patients and improved in an additional 6 % of T2DM cases . Only 7 % of patients are still maintained on antidiabetic medications . In patients with more than 1 year f/u , most other comorbidities were improved or resolved . Conclusions Long-term f/u of LREYGB in veteran patients demonstrated significant and durable weight loss ( 56 % EWL ) with marked improvements in comorbidities especially T2DM to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely 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 The efficacy of three gastric restriction operations were compared in a prospect i ve r and omized study of 310 morbidly obese subjects . The median patient age was 34 years ( range , 18 to 62 years ) . They were predominantly female ( 13:1 ) and had a median pre-operative weight that was 198 % of their ideal weight ( range , 160 % to 318 % ) . There was an equitable dispersion of perceived risk factors between the groups under study and there were no deaths during the perioperative period . Compliance with follow-up at 3 years was 91 % . When success was defined as a loss of more than 50 % of excess weight or a current pregnancy , the success rates at 3 years were 17 % for gastrogastrostomy , 48 % for vertical gastroplasty , and 67 % for Roux-en-Y gastric bypass ( p less than 0.001 ) . Although the gastric bypass operation took longer to perform , there were similar outcome patterns for the three groups during the postoperative period . We conclude that the Roux-en-Y gastric bypass is the preferred procedure for the surgical treatment of morbid obesity Background : In the non-superobese population , consensus is currently unavailable in bariatric surgery . We report the results of a prospect i ve comparison of vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGBP ) in a non-superobese population . Methods : From 1994 to 2000 , 179 patients with clinical ly severe obesity underwent various surgical procedures in our department . During this time a prospect i ve study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI < 50 kg/m2 . Based on specific criteria including eating behavior , 68 patients were selected to undergo RYGBP and 35 VBG . All patients have undergone complete follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results : All patients have now completed their 5th postoperative year . Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP . 3 patients ( 8.6 % ) in the VBG group and 9 patients ( 13.2 % ) in the RYGBP group are lost to follow-up . Mean excess weight loss ( EWL ) was always better in the RYGBP group ( P=0.0013 ) . The percentage of failure , defined as EWL < 25 % , was not significantly different between the two procedures . No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications , and the only statistically significant difference observed in metabolic complications was vitamin B12 deficiency after RYGBP . Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients . Conclusion : This prospect i ve long-term study , with nearly complete follow-up , suggests that in the non-superobese population , preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient . Although RYGBP is associated with better mean weight loss outcomes , the percentage of patients who achieved and maintained ≥50 % EWL after VBG in this pre-selected patient population was not significantly different . Each type of operation has advantages and disadvantages , and , if properly chosen , a purely restrictive procedure can be successful for some patients . Therefore , it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients ' own preferences and outcome expectations 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 Laparoscopic Roux-en-Y gastric bypass surgery ( RYGB ) was introduced at the authors ’ institution 5 years ago . The authors analyzed the short- and long-term results of this procedure compared with those for the same procedure using the laparotomy approach over the same period . Methods Retrospective analysis of a prospect ively collected bariatric data base used the outcome end points used by the American Society of Bariatric Surgery ( ASBS ) and the American College of Surgeons ( ACS ) in their center of excellence programs . Results From January 2001 to July 2005 , 568 laparoscopic and 399 open gastric bypasses were performed at V and erbilt University . The patients were from the same bariatric surgery program and therefore received the same pre- and postoperative care . The hospital length of stay in the laparoscopic group was significantly shorter ( 2.5 ± 2.4 days ) than in the open group ( 3.7 ± 3.7 days ; p = 0.001 ) . The procedure time was significantly shorter in the laparoscopic group ( 164 ± 50 min ) than in the open group ( 195 ± 50 min ; p = 0.0001 ) . The follow-up assessment response at 2 years was 76.6 % . At 2 years , the excess weight loss ( EWL ) was significantly greater in the laparoscopic group ( 71.3 % ± 18.4 % ) than in the open group ( 67.3 % ± 15.3 % ; p = 0.03 ) . The wound infection rate was significantly higher in open group ( 9.2 % ) than in the laparoscopic group ( 1.7 % ; p = 0.001 ) . There was no significant difference in 30-day mortality : open ( 0.50 % ) versus laparoscopic ( 0.17 % ; p = 0.371 ) . There was no significant difference in the 30-day reoperation rate between the open ( 2.4 % ) and laparoscopic ( 2.6 % ; p = 0.705 ) groups . The 30-day readmission rate was similar in the open ( 5.0 % ) and laparoscopic ( 5.2 % ; p = 0.852 ) groups , as was the rate of leakage from the gastrojejunostomy in the open ( 0.50 % ) and laparoscopic ( 0.35 % ; p = 0.127 ) groups . The conversion rate from laparoscopic procedure to laparotomy was 1.7 % . Conclusion In the authors ’ institution , a laparoscopic bariatric surgery program with a very low rate of morbidity and mortality has been introduced . Operative time , hospital stay , and wound complications are reduced with the laparoscopic approach . The laparoscopic and open procedures are equally safe , with equivalent 30-day mortality , readmission , reoperation , and gastrojejunostomy leakage rates 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 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 Background The objective of this study was to study the long-term outcome of adjustable gastric b and ing in the treatment of morbid obesity . In Europe , the preference for gastric b and has declined in favor of Roux-Y-gastric bypass . Methods This is a follow-up of a prospect i ve study on a large cohort of patients after laparoscopic gastric b and ing ( LAGB ) for morbid obesity . Results Complete data were collected on 656 patients ( 88 % ) from a cohort of 745 patients . After a median follow-up of 95 months ( range 60–155 ) , the mean BMI dropped from 41.0 ± 7.3 to 33.2 ± 7.1 kg/m2 , with a 46.2 ± 36.5 % excess weight loss ( EWL ) . A more than 50 % EWL was achieved in 44 % of patients . The b and was still in place in 77.1 % of patients ; conversion to gastric bypass after b and removal was carried out in 98 ( 14.9 % ) patients , while a simple removal was done in only 52 ( 7.9 % ) patients . B and removal was more likely in women and patients with a higher BMI . Conclusions After LAGB , b and removal was necessary for complications or insufficient weight loss in 24 % of patients . Nearly half of the patients achieved a more than 50 % EWL , but in 88 % , a more than 10 % EWL was observed . LAGB can achieve an acceptable weight loss in some patients , but the failure in one out of four patients does not allow proposing it as a first-line option for the treatment of obesity Since the last comprehensive review of anticoagulation in acute myocardial infa rct ion four additional r and omized control trials have been reported . The overwhelming majority of all trials favored anticoagulation .  Rates of thromboembolism were higher in the control , and hemorrhagic complications in the anticoagulated group . Pooling of all r and omized control trials gives mean case fatality rates of 19.6 % for the control and 15.4 % for the anticoagulated group , a relative reduction of 21 % ( P less than 0.05 or less than 0.001 , depending on the analytic method ) . Five of six r and omized control trials reported " no effect " because the difference favoring anticoagulation was not statistically significant . However , sample sizes in these " negative " papers were too small to protect against missing a 21 % reduction in true case fatality rate due to anticoagulation ( beta greater than 0.10 ) . All patients who present no specific contraindication should receive  anticoagulants  during hospitalization for infa rct ion BACKGROUND Evidence of the positive effects of gastric b and ing on patients with diabetes has continued to increase . The long-term follow-up of such patients , however , has been limited . The purpose of the present study was to provide the long-term outcomes of patients with diabetes undergoing laparoscopic adjustable gastric b and ing at our institution . METHODS From January 2002 through June 2004 , 102 patients with type 2 diabetes mellitus underwent laparoscopic adjustable gastric b and ing .  The study parameters included preoperative age , gender , race , body mass index , duration of diabetes before surgery , fasting glucose level , hemoglobin A1c ( HbA1c ) , and medications used . Preoperative data from all patients were collected prospect ively and entered into an institutional review board-approved data base . Beginning in 2008 , efforts were made to collect the 5-year follow-up data . RESULTS Of the 102 patients , 7 were excluded because they had not reached the 5-year follow-up point ( 2 patients had had the b and removed early and 5 patients had died ; 2 of cancer and 3 of unknown causes ) , leaving 95 patients for the present study . The mean preoperative age was 49.3 years ( range 21.3 - 68.4 ) . The mean preoperative body mass index was 46.3 kg/m(2 ) ( range 35.1 - 71.9 ) and had decreased to 35.0 kg/m(2 ) ( range 21.1 - 53.7 ) by 5 years of follow-up , yielding a mean percentage of excess weight loss of 48.3 % . The mean duration of the diabetes diagnosis before surgery was 6.5 years . Of 94 patients , 83 ( 88.3 % ) were taking medications preoperatively , with 14.9 % overall taking insulin . At 5 years postoperatively , 33 ( 46.5 % ) of 71 patients were taking medications , with 8.5 % taking insulin . The mean fasting preoperative glucose level was 146.0 mg/dL. The glucose level had decreased to 118.5 mg/dL at 5 years postoperatively ( P = .004 ) . The mean HbA1c level was 7.53 preoperatively in 72 patients and was 6.58 at 5 years postoperatively in 64 patients ( P < .001 ) . Overall , diabetes had resolved ( no medication requirement , with HbA1c < 6 and /or glucose < 100 mg/dL ) in 23 ( 39.7 % ) of 58 patients and had improved ( use of fewer medications and /or fasting glucose levels of 100 - 125 mg/dL ) in 41 ( 71.9 % ) of 57 patients . The combined improvement/remission rate was 80 % ( 64 of 80 patients ) . CONCLUSION Our data have demonstrated that laparoscopic adjustable gastric b and ing results in a substantial sustained positive effect on diabetes in morbidly obese patients , with a significant reduction in HbA1c and an 80 % overall rate of improvement/remission Objective : The objective of this study was to evaluate the results of laparoscopic gastric b and ing using 2 different b and s ( the Lapb and [ Bioenterics , Carpinteria , CA ] and the SAGB [ Swedish Adjustable Gastric B and ; Obtech Medical , 6310 Zug , Switzerl and ] ) in terms of weight loss and correction of comorbidities , short- and long-term complications , and improvement of quality of life in morbidly obese patients Summary Background Data : During the past 10 years , gastric b and ing has become 1 of the most common bariatric procedures , at least in Europe and Australia . Weight loss can be excellent , but it is not sufficient in a significant proportion of patients , and a number of long-term complications can develop . We hypothesized that the type of b and could be of importance in the outcome . Methods : One hundred eighty morbidly obese patients were r and omly assigned to receive the Lapb and or the SAGB . All the procedures were performed by the same surgeon . The primary end point was weight loss , and secondary end points were correction of comorbidities , early- and long-term complications , importance of food restriction , and improvement of quality of life . Results : Initial weight loss was faster in the Lapb and group , but weight loss was eventually identical in the 2 groups . There was a trend toward more early b and -related complications and more b and infections with the SAGB , but the study had limited power in that respect . Correction of comorbidities , food restriction , long-term complications , and improvement of quality of life were identical . Only 55 % to 60 % of the patients achieved an excess weight loss of at least 50 % in both groups . There was no difference in the incidence of long-term complications . Conclusions : Gastric b and ing can be performed safely with the Lapb and or the SAGB with similar short- and midterm results with respect to weight loss and morbidity . Only 50 % to 60 % of the patients will achieve sufficient weight loss , and close to 10 % at least will develop severe long-term complications Background Although the efficacy of laparoscopic sleeve gastrectomy ( LSG ) for morbidly obese patients with a BMI of < 50 kg/m2 , the incidence of weight gain by change of eating behaviors , and gastric dilatation following LSG have not been investigated thus far , LSG is becoming more common as a single-stage operation for the treatment morbid obesity . Methods This is a prospect i ve study of the initial 120 patients who underwent isolated LSG .  Initially , the LSG was performed without a calibration tube and result ed in high sleeve volumes ( group 1 : n=25 ) . In group 2 ( n=32 ) , a calibration tube of 44 Fr and in group 3 ( n=63 ) a calibration tube of 32 Fr were used . The study group consists of 101 patients with high BMI who were scheduled for a two-step LBPD-DS , but rejected the second step after 1 year . Study endpoints include estimated sleeve volume , volume of removed stomach , operative time , complication rates , length of hospital stay , changes in co-morbidity , percentage of excess BMI loss ( % EBL ) and changes in BMI ( kg/m2 ) . Results All 3 groups were comparable regarding age , gender , and co-morbidities . There was no hospital mortality , but there was one case of late mortality ( 0.8 % ) . 2 early leaks ( 1.7 % ) were seen . % excess BMI loss was significantly higher for patients who underwent LSG with tube calibrations . LSG with large sleeve volume showed a slight weight gain during 5 years of observation . A total of 16 patients ( 13.3 % ) underwent a second stage procedure within a period of 5 years ( 2 redo-sleeves , 7 LBPD-DS , 3 LRYGBP ) . Conclusion Early weight loss results were not different between the groups , but after 2 years the more restrictive LSG ( groups 2 , 3 ) results were significantly better than in patients without calibration . A removed gastric volume of < 500 cc seems to be a predictor of failure in treatment or early weight regain . A statistically significant improved health status and quality of life were registered for all groups . The general introduction of LSG as a one-stage restrictive procedure in the bariatric field can be considered only if the procedure is st and ardized and long-term results are available CONTEXT Extreme obesity is associated with health and cardiovascular disease risks . Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term , long-term outcomes are uncertain . OBJECTIVE To examine the association of  Roux-en-Y gastric bypass ( RYGB ) surgery  with weight loss , diabetes mellitus , and other health risks 6 years after surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese ( body mass index [ BMI ] ≥ 35 ) participants aged 18 to 72 years ( 82 % women ; mean BMI , 45.9 ; 95 % CI , 31.2 - 60.6 ) who sought and received RYGB surgery ( n = 418 ) , sought but did not have surgery ( n = 417 ; control group 1 ) , or who were r and omly selected from a population -based sample not seeking weight loss surgery ( n = 321 ; control group 2 ) . MAIN OUTCOME MEASURES Weight loss , diabetes , hypertension , dyslipidemia , and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment . RESULTS Six years after surgery , patients who received RYGB surgery ( with 92.6 % follow-up ) lost 27.7 % ( 95 % CI , 26.6%-28.9 % ) of their initial body weight compared with 0.2 % ( 95 % CI , -1.1 % to 1.4 % ) gain in control group 1 and 0 % ( 95 % CI , -1.2 % to 1.2 % ) in control group 2 . Weight loss maintenance was superior in patients who received RYGB surgery , with 94 % ( 95 % CI , 92%-96 % ) and 76 % ( 95 % CI , 72%-81 % ) of patients receiving RYGB surgery maintaining at least 20 % weight loss 2 and 6 years after surgery , respectively . Diabetes remission rates 6 years after surgery were 62 % ( 95 % CI , 49%-75 % ) in the RYGB surgery group , 8 % ( 95 % CI , 0%-16 % ) in control group 1 , and 6 % ( 95 % CI , 0%-13 % ) in control group 2 , with remission odds ratios ( ORs ) of 16.5 ( 95 % CI , 4.7 - 57.6 ; P < .001 ) vs control group 1 and 21.5 ( 95 % CI , 5.4 - 85.6 ; P < .001 ) vs control group 2 . The incidence of diabetes throughout the course of the study was reduced after RYGB surgery ( 2 % ; 95 % CI , 0%-4 % ; vs 17 % ; 95 % CI , 10%-24 % ; OR , 0.11 ; 95 % CI , 0.04 - 0.34 compared with control group 1 and 15 % ; 95 % CI , 9%-21 % ; OR , 0.21 ; 95 % CI , 0.06 - 0.67 compared with control group 2 ; both P < .001 ) . The numbers of participants with bariatric surgery-related hospitalizations were 33 ( 7.9 % ) , 13 ( 3.9 % ) , and 6 ( 2.0 % ) for the RYGB surgery group and 2 control groups , respectively . CONCLUSION Among severely obese patients , compared with nonsurgical control patients , the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years 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 : For many years it has been cl aim ed that observational studies find stronger treatment effects than r and omized , controlled trials . We compared the results of observational studies with those of r and omized , controlled trials . METHODS : We search ed the Abridged Index Medicus and Cochrane data bases to identify observational studies reported between 1985 and 1998 that compared two or more treatments or interventions for the same condition . We then search ed the Medline and Cochrane data bases to identify all the r and omized , controlled trials and observational studies comparing the same treatments for these conditions . For each treatment , the magnitudes of the effects in the various observational studies were combined by the Mantel-Haenszel or weighted analysis -of-variance procedure and then compared with the combined magnitude of the effects in the r and omized , controlled trials that evaluated the same treatment . RESULTS : There were 136 reports about 19 diverse treatments , such as calcium-channel-blocker therapy for coronary artery disease , appendectomy , and interventions for subfertility .  In most cases , the estimates of the treatment effects from observational studies and r and omized , controlled trials were similar . In only 2 of the 19 analyses of treatment effects did the combined magnitude of the effect in observational studies lie outside the 95 percent confidence interval for the combined magnitude in the r and omized , controlled trials . CONCLUSIONS : We found little evidence that estimates of treatment effects in observational studies reported after 1984 are either consistently larger than or qualitatively different from those obtained in r and omized , controlled trials Bariatric surgery ameliorates  obesity‐associated diseases  , result ing in psychological and social benefits . Long‐term studies of its effects on quality of life ( QOL ) assessed with well established instruments are lacking . This prospect i ve study investigated the long‐term effects of  gastric b and ing  on health‐related QOL using an obesity‐specific vali date d measure Background : Since its introduction about 10 years ago , and because of its encouraging early results regarding weight loss and morbidity ,  laparoscopic gastric b and ing ( LGB ) has been considered by many as the treatment of choice for morbid obesity . Few long-term studies have been published . We present our results after up to 8 years ( mean 74 months ) of follow-up . Methods : Prospect i ve data of patients who had LGB have been collected since 1995 , with exclusion of the first 30 patients ( learning curve ) . Major late complications are defined as those requiring b and removal ( major reoperation ) , with or without conversion to another procedure . Failure is defined as an excess weight loss ( EWL ) of < 25 % , or major reoperation . Results : Between June 1997 and June 2003 , LGB was performed in 317 patients , 43 men and 274 women . Mean age was 38 years ( 19 - 69 ) , mean weight was 119 kg ( 79 - 179 ) , and mean BMI was 43.5 kg/m2 ( 34 - 78 ) . 97.8 % of the patients were available for follow-up after 3 years , 88.2 % after 5 years , and 81.5 % after 7 years . Overall , 105 ( 33.1 % ) of the patients developed late complications , including b and erosion in 9.5 % , pouch dilatation/slippage in 6.3 % , and catheter- or port-related problems in 7.6 % . Major reoperation was required in 21.7 % of the patients . The mean EWL at 5 years was 58.5 % in patients with the b and still in place . The failure rate increased from 13.2 % after 18 months to 23.8 % at 3 , 31.5 % at 5 , and 36.9 % at 7 years . Conclusions : LGB appeared promising during the first few years after its introduction , but results worsen over time , despite improvements in the operative technique and material . Only about 60 % of the patients without major complication maintain an acceptable EWL in the long term . Each year adds 3 - 4 % to the major complication rate , which contributes to the total failure rate . With a nearly 40 % 5-year failure rate , and a 43 % 7-year success rate ( EWL > 50 % ) , LGB should no longer be considered as the procedure of choice for obesity . Until reliable selection criteria for patients at low risk for long-term complications are developed , other longer lasting procedures should be used Objective : To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy ( LSG )  as compared to the laparoscopic adjustable gastric b and ( LAGB ) , the laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and the open Roux-en-Y gastric bypass ( ORYGB ) for the treatment of obesity and obesity-related diseases . Background : LSG is a newer procedure being done with increasing frequency . However , limited data are currently available comparing LSG to the other established procedures . We present the first prospect i ve , multiinstitutional , nationwide , clinical ly rich , bariatric-specific data comparing  sleeve gastrectomy to the adjustable gastric b and , and the gastric bypass . Methods : This is the initial report analyzing data from the American College of Surgeons — Bariatric Surgery Center Network accreditation program , and its prospect i ve , longitudinal , data collection system based on st and ardized definitions and collected by trained data review ers . Univariate and multivariate analyses compare 30-day , 6-month , and 1-year outcomes including morbidity and mortality , readmissions , and reoperations as well as reduction in body mass index ( BMI ) and weight-related comorbidities . Results : One hundred nine hospitals su bmi tted data for 28,616 patients , from July , 2007 to September , 2010 . The LSG has higher risk-adjusted morbidity , readmission and reoperation/intervention rates compared to the LAGB , but lower reoperation/intervention rates compared to the LRYGB and ORYGB . There were no differences in mortality . Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB . Conclusion : LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year . As obesity is a lifelong disease , longer term comparative effectiveness data are most critical , and are yet to be determined Loss to follow-up is problematic in most cohort studies and often leads to bias . Although guidelines suggest acceptable follow-up rates , the authors are unaware of studies that test the validity of these recommendations . The objective of this study was to determine whether the recommended follow-up thresholds of 60–80 % are associated with biased effects in cohort studies . A simulation study was conducted using 1000 computer replications of a cohort of 500 observations . The logistic regression model included a binary exposure and three confounders . Varied correlation structures of the data represented various levels of confounding . Differing levels of loss to follow-up were generated through three mechanisms : missing completely at r and om ( MCAR ) , missing at r and om ( MAR ) and missing not at r and om ( MNAR ) . The authors found no important bias with levels of loss that varied from 5 to 60 % when loss to follow-up was related to MCAR or MAR mechanisms . However , when observations were lost to follow-up based on a MNAR mechanism , the authors found seriously biased estimates of the odds ratios with low levels of loss to follow-up . Loss to follow-up in cohort studies rarely occurs r and omly . Therefore , when planning a cohort study , one should assume that loss to follow-up is MNAR and attempt to achieve the maximum follow-up rate possible BACKGROUND The effectiveness and safety of bariatric surgery using laparoscopic adjustable gastric b and s have been demonstrated in numerous published studies . We present the results of the first U.S. multicenter trial of the Realize adjustable gastric b and , a laparoscopic adjustable gastric b and previously available only outside the United States as the Swedish adjustable gastric b and . METHODS A total of 405 morbidly obese patients were screened at 12 different centers from May to November 2003 to participate in a prospect i ve , single-arm study of the safety and effectiveness of the laparoscopically implanted Realize b and . Changes in excess body weight , the parameters of diabetes and dyslipidemia , and the incidence of complications were assessed at 3 years of follow-up . RESULTS Of the 405 patients , 276 ( 78.3 % women and 61.2 % white ) qualified for the study . The average age was 38.6 + or - 9.4 years ( range 18 - 61 ) , and the preoperative body mass index was 44.5 + or - 4.7 kg/m(2 ) . The mean hospital stay was 1.2 + or - 1.3 days . At 3 years , the average excess weight loss was 41.1 % + or - 25.1 % or a decrease in the body mass index of 8.2 kg/m(2 ) ( 18.6 % ) ( P < .001 ) . In diabetic patients with a baseline elevated hemoglobin A(1)c level , the level decreased by 1 % ( P < .001 ) . The total cholesterol , low-density lipoprotein cholesterol , and triglycerides decreased by 9 % , 16 % , and 50 % , respectively ( P < .001 ) , and the high-density lipoprotein cholesterol increased by 25 % ( P < .001 ) in patients with abnormal baseline values . One patient required conversion to an open surgical technique . No 30-day mortality occurred . The complication frequencies were generally low and included esophageal dysmotility in 0.4 % , late balloon failure in 0.4 % , b and erosion in 0.4 % , slippage in 3.3 % , esophageal dilation in 3.3 % , pouch dilation in 3.6 % , catheter kinking in 1.1 % , port displacement in 2.5 % , and port disconnection in 4.3 % . Reoperations were required in 15.2 % of the patients and involved 2 b and replacements , 9 b and revisions , 5 port replacements , 22 port revisions , and 4 explants . CONCLUSION The results of our study have shown that the Realize adjustable gastric b and is safe and effective in a diverse U.S. population of morbidly obese patients .  Significant weight loss was achieved throughout the 3 years of follow-up , with corresponding improvements in the indicators of diabetes and dyslipidemia BACKGROUND To improve decision making in the treatment of extreme obesity , the risks of bariatric surgical procedures require further characterization . METHODS We performed a prospect i ve , multicenter , observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007 . A composite end point of 30-day major adverse outcomes ( including death ; venous thromboembolism ; percutaneous , endoscopic , or operative reintervention ; and failure to be discharged from the hospital ) was evaluated among patients undergoing first-time bariatric surgery .  RESULTS There were 4776 patients who had a first-time bariatric procedure ( mean age , 44.5 years ; 21.1 % men ; 10.9 % nonwhite ; median body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 46.5 ) . More than half had at least two coexisting conditions . A Roux-en-Y gastric bypass was performed in 3412 patients ( with 87.2 % of the procedures performed laparoscopically ) , and laparoscopic adjustable gastric b and ing was performed in 1198 patients ; 166 patients underwent other procedures and were not included in the analysis . The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing was 0.3 % ; a total of 4.3 % of patients had at least one major adverse outcome . A history of deep-vein thrombosis or pulmonary embolus , a diagnosis of obstructive sleep apnea , and impaired functional status were each independently associated with an increased risk of the composite end point . Extreme values of body-mass index were significantly associated with an increased risk of the composite end point , whereas age , sex , race , ethnic group , and other coexisting conditions were not . CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics . In helping patients make appropriate choices , short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese . ( Clinical Trials.gov number , NCT00433810 .
target: Gastric bypass has better outcomes than gastric b and procedures for long-term weight loss , type 2 diabetes control and remission , hypertension , and hyperlipidemia .
  Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections
background: IMPORTANCE Bariatric surgery is an accepted treatment for obesity .
  Despite extensive literature , few studies report long-term follow-up in cohorts with adequate retention rates .
  OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss , type 2 diabetes , hypertension , and hyperlipidemia in severely obese adults .