title: Laparoscopic Roux-en-Y Gastric Bypass and Its Early Effect on Blood Pressure Laparoscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Life at One Year Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Subgroup analyses of the major clinical endpoints in the Program on the Surgical Control of the Hyperlipidemias (POSCH): overall mortality, atherosclerotic coronary heart disease (ACHD) mortality, and ACHD mortality or myocardial infarction. The Laparoscopic Adjustable Gastric Band (Lap-Band®): A Prospective Study of Medium-Term Effects on Weight, Health and Quality of Life The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Effect of Lap-Band®-Induced Weight Loss on Type 2 Diabetes Mellitus and Hypertension Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs Health benefits of gastric bypass surgery after 6 years. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity 
  
abstract: Background  Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) surgery  is known to have a significant effect on obesity-related comorbidities such as hypertension curing it in some ( 50–70 % ) while improving control in others . Our aim was to observe the changes in blood pressure ( BP ) in a cohort of 100 patients followed prospect ively for 1 year after LRYGB .  Methods BP measurements were recorded prospect ively in 100 consecutive patients preoperatively and then postoperatively at weeks 1 , 5 , 9 , and months 6 and 12 . In order to reduce bias , three BP measurements were made by the same nurse at each office visit and the mean recorded . Pre- and postoperative usage of antihypertensive medication was also noted . Results Eighty-nine women and 11 men underwent LRYGB and their BP monitored for 1 year . There was an 85 % follow-up rate with mean % excess body weight loss of 60 . Reductions in systolic ( 9 mmHg ) and diastolic ( 7 mmHg ) BP measurements were seen as early as week 1 postoperatively and maintained for the duration of the observation period ( P < 0.05 ) . Furthermore , postoperative usage of antihypertensive medication is reduced to a third of preoperative use . Conclusion  LRYGB  is associated with an early reduction in BP and antihypertensive medication usage which is maintained at 1 year after surgery . This early impact on blood pressure occurs before any significant weight loss is achieved thereby suggesting a hormonal mechanism that may be involved for the changes observed Background : The objective of this study was to determine the weight loss , changes in co-morbidities , medication usage and general health status at 1 year after laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : Prospect i ve data were obtained from all subjects undergoing LAGB .  These measurements included a medical history and review of systems , medications , height and weight and the SF-36 general health survey . Patients were seen for b and adjustments as needed throughout the year . At the 1-year follow-up visit , patients were weighed and interviewed about the status of their health conditions and their current medications , and the SF-36 was repeated . Results : Between November 2002 and November 2003 , 195 patients had LAGB . The majority of subjects were female ( 82.8 % ) , married ( 65.1 % ) , and white ( 94.9 % ) .  Complications occurred in 18 subjects ( 9.2 % ) . These included 3 slipped b and s ( 1.5 % ) , 4 port problems ( 2.1 % ) , 8 patients with temporary stoma occlusion ( 4.1 % ) , 1 explantation ( 0.5 % ) , and 1 mortality ( 0.5 % ) . Mean BMI decreased from 45.8 kg/m2 ( ± 7.7 ) to 32.3 kg/m2 ( ± 7.0 ) . Mean percent excess body weight lost was 45.7 % ( ± 17.1 ) during the first year . Major improvements occurred in arthritis , asthma , depression , diabetes , gastro-esophageal reflux disease , hyperlipidemia , hypertension , joint and back pain , sleep apnea and stress incontinence . Medication usage declined remarkably . Quality of life ( QoL ) by the SF-36 showed highly significant improvements . Conclusions : At 1 year after LAGB , patients had experienced significant weight loss , resolution of comorbidities , decreases in medication usage , and improvements in BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure HYPOTHESIS Outcome following laparoscopic adjustable gastric b and ing ( LAGB )  in super morbidly obese patients is significantly worse compared with the st and ard laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . DESIGN Prospect i ve case series . SETTING Community teaching hospital ( 490 beds ) . PATIENTS A prospect ively maintained data base identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004 . The study group included super morbidly obese patients ( body mass index > 50 [ calculated as weight in kilograms divided by the square of height in meters ] ) following LAGB and LRYGB .  INTERVENTIONS Among 106 patients with super morbid obesity , 60 ( 57 % ) and 46 ( 43 % ) underwent LAGB and LRYGB  , respectively . MAIN OUTCOME MEASURES Patient demographics , weight loss , percentage of excess weight loss , change in body mass index , early ( < 30 days ) and late ( > or = 30 days ) complications , reoperations , medical comorbidity , and patient satisfaction were studied . Analysis was performed using the t test and Pearson chi 2 analysis . RESULTS Overall median follow-up was 16.2 months ( range , 1 - 40 months ) . Preoperative factors of patient age , sex , weight , body mass index , and medical comorbidity were similar between the 2 groups . Compared with LRYGB , patients who underwent LAGB experienced a greater incidence of late complications ( P < .05 ) , reoperations ( P < .04 ) , less weight loss ( P<.001 ) , and decreased overall satisfaction ( P < .006 ) . Likewise , patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus ( P < .05 ) and sleep apnea ( P<.01 ) compared with the LAGB group . Furthermore , postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations . Our single mortality was in the LAGB group . CONCLUSIONS In super morbidly obese patients , LAGB is significantly associated with more late complications , reoperations , less weight loss , less reduction of medical comorbidity , and patient dissatisfaction compared with LRYGB . Further evaluation of LAGB in this patient population appears warranted The Program on the Surgical Control of the Hyperlipidemias ( POSCH ) was a secondary atherosclerosis intervention trial employing partial ileal bypass surgery as the intervention modality . For this report , we analyzed 105 subgroups in 35 variables in POSCH , chosen predominantly for their potential relationship to the risk of atherosclerotic coronary heart disease ( ACHD ) . We defined potential differential effects as those with : ( 1 ) an absolute z-value > or = 2.0 for the subgroup , if the absolute z-value for the overall effect was < 2.0 ; and ( 2 ) an absolute z-value > or = 3.0 for the subgroup and a relative risk < or = 0.5 , if the absolute z-value for the overall effect was > or = 2.0 . For each of three major POSCH endpoints of overall mortality , ACHD mortality and ACHD mortality or confirmed nonfatal myocardial infa rct ion , we found seven subgroups with a differential risk reduction in the surgery group as compared to the control group . Allowing for identical subgroups for more than one endpoint , there were 13 individual subgroups with differential effects . Of these , seven demonstrated internal consistency across endpoints , and five of these seven displaced external consistency with known ACHD risk factors and for biological plausibility : triglyceride concentration > or = 200 mg/dl ; cigarette smoking ; overt or borderline diabetes mellitus ; a Minnesota ECG Q-QS code of 1 - 1 ; and obesity . A greater risk reduction , in comparison to the overall treatment effect , by the reduction of a single risk factor , hypercholesterolemia , in patients with at least two major ACHD risk factors was a provocative and an hypothesis-generating outcome of this analysis . The clinical implication s of this finding may lead to more aggressive cholesterol intervention in patients with multiple ACHD risk factors Background : Obesity is now one of our major public health problems . Effective and acceptable treatment options are needed . The Lap-B and ® system is placed laparoscopically and allows adjustment of the level of gastric restriction . Methods : A prospect i ve study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center . After extensive preoperative evaluation , patients with a body mass index > 35 were treated by  LapB and ® placement . Close follow-up with progressive adjustment of gastric restriction continued permanently . Medical co-morbidities were monitored as part of comprehensive prospect i ve data collection . Results : There have been no deaths perioperatively or during follow-up . Significant perioperative adverse events occurred in 1.2 % only . Reoperation has been needed for prolapse ( slippage ) in 12.5 % , erosion of the b and into the stomach in 2.8 % and for tubing breaks in 3.6 % . A steady progression of weight loss has occurred through the duration of the study with 52 ± 19 % EWL at 24 months ( n=333 ) , 53±22 % EWL at 36 months ( n=264 ) , 52 ± 24 % EWL at 48 months ( n=108 ) , 54 ± 24 % EWL at 60 months ( n=30 ) , and 57 ± 15 % EWL at 72 months ( n=10 ) . Major improvements have occurred in diabetes , asthma , gastroesophageal reflux , dyslipidemia , sleep apnea and depression . Quality of life as measured by R and SF-36 shows highly significant improvement . Conclusions : Placement of the Lap-B and ® system provides safe and effective control of severe obesity . The effect on weight loss is durable and is associated with major improvement in health and quality of life . It has the potential to provide a broadly acceptable option for this common and serious disease AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme Background : Severe obesity is associated with type 2 diabetes and hypertension . Improvement in these comorbidities after surgically-induced weight loss has been documented , and laparoscopic adjustable gastric b and ing ( LAGB ) is an effective weight loss operation . Methods : Of 840 patients who underwent Lap-B and ® , data are available in 402 out of 413 patients whose surgery took place at ≥ 1 year ago . Preoperative and follow-up data were studied retrospectively to examine the effect of Lap-B and ® -induced weight loss on diabetes and hypertension . Results : Of 413 patients with at least 1 year postoperative follow-up , 53 ( 12.8 % ) were taking medications for type 2 diabetes preoperatively and 189 ( 45.7 % ) were on antihypertensive medications . 66 % ( n=35 ) of diabetic patients were also hypertensive . Resolution of diabetes was observed in 66 % at 1-year and 80 % at 2-year follow-up . HbA1c dropped from 7.25 % ( 5.6 - 11.0 , n=53 ) preoperatively to 5.58 % ( 5.0 - 6.2 , n=15 ) at 2 years after surgery . Hypertension resolved in 59.8 % and 74 % at 1 and 2 years , respectively . Percent excess weight loss ( % EWL ) was lower for diabetic patients than for our cohort population ( 39.2 % vs 41.2 % at 1 year , 46.7 % vs 54.2 % at 18 months , and 52.6 % vs 63.3 % at 2 years , respectively ) . Patients in whom diabetes was improved but not resolved had lower % EWL than did those whose diabetes went into remission ( 27.0 % at 1 year and 26.5 % at 2 years ) . Patients with the shortest duration of diabetes ( < 5 years ) and better weight loss after surgery achieved higher resolution rates . Conclusions : Dramatic improvement in – and frequent resolution of – diabetes and hypertension have been observed as a result of weight loss after Lap-B and ® surgery Objective To compare outcomes , quality of life ( QOL ) , and costs of laparoscopic and open gastric bypass ( GBP ) .  Summary Background Data Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity . The authors performed a prospect i ve r and omized trial to compare outcomes , QOL , and costs of laparoscopic GBP with those of open GBP . Methods From May 1999 to March 2001 , 155 patients with a body mass index ( BMI ) of 40 to 60 kg/m2 were r and omly assigned to undergo laparoscopic ( n = 79 ) or open ( n = 76 ) GBP .  The two groups were similar in age , sex ratio , mean BMI , and comorbidities . Main outcome measures included operative time , estimated blood loss , length of hospital stay , operative complications , percentage of excess body weight loss , and time to return to activities of daily living and work . Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system ( BAROS ) . Operative and hospital costs of the two operations were also compared . Results There were no deaths in either group . Mean operative time was longer for laparoscopic GBP than for open GBP , but operative blood loss was less . Two ( 2.5 % ) of the 79 patients in the laparoscopic group required conversion to laparotomy . Median length of hospital stay was shorter for laparoscopic GBP patients ( 3 vs 4 days ) . The rate of postoperative anastomotic leak was similar between groups . Wound-related complications such as infection ( 10.5 vs 1.3 % ) and incisional hernia ( 7.9 vs 0 % ) were more common after open GBP ; late anastomotic stricture was less frequent after open GBP ( 2.6 vs 11.4 % ) . Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP .  Weight loss at 1 year was similar between groups . Preoperative SF-36 scores were similar between groups ; however , at 1 month after surgery , laparoscopic patients had better physical conditioning , social functioning , general health , and less body pain than open GBP patients . At 6 months , the BAROS outcome was classified as good or better in 97 % of laparoscopic GBP patients compared with 82 % of open GBP patients . Operative costs were higher for laparoscopic GBP patients , but hospital costs were lower . Conclusions Laparoscopic GBP is a safe and cost-effective alternative to open GBP . Despite a longer operative time , patients undergoing laparoscopic GBP benefited from less blood loss , a shorter hospital stay , and faster convalescence .  Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients . The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs 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 : Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population . We report an outcome analysis of our early experience with laparoscopic Roux-en-Y gastric bypass ( LRYGB )  in the treatment of morbid obesity . Methods : Two surgeons performed 116 consecutive LRYGBs at a single institution , creating a 25-ml pouch and a 90- to 150-cm Roux limb . The prospect ively collected data included patient demographics , comorbidities , postoperative weight loss , and complications . Results : All eight conversions to an open procedure occurred early during the experience of the surgeons . The mean operating room time for the first 50 cases was 272 min , which decreased to 198 min with experience . The mean length of hospital stay was 3 days . There were 34 complications in 27 patients ( 23.3 % ) , 14 of which ( 12 % ) required reoperation . At 18 months postoperatively , the patients had lost 77 % of their excess weight , and their body mass index had decreased from a mean of 49.3 to 32.6 kg/m2 . As a result of LRYGB , 25 % of the patients were rendered completely free of any pharmacologic treatment for their preexisting comorbidities . Conclusions : Although technically challenging , LRYGB can be performed safely with excellent long-term results . The mean operating room time and conversion rate improved with experience . As this study showed , LRYGB achieves an excellent rate of weight loss and improvement in preoperative comorbidities with a minimal length of hospital stay and an acceptable complication rate
target: Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction .
  Conclusions The present study showed an overall reduction of cardiovascular risk after bariatric surgery .
  In summary , our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients
background: Background This study aims to evaluate the 12–24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease .