Efficacy Of Bariatric Surgery Research Articles

Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease.

Obesity has become prevalent in patients with inflammatory bowel disease (IBD). Bariatric surgery can be considered to be contraindicated in IBD patients. We aimed to evaluate feasibility, safety, and efficacy of bariatric surgery in IBD patients. We retrospectively identified all morbidly obese patients with a known diagnosis of IBD, who underwent bariatric surgery between January 2005 and December 2012. Postoperative outcomes and status of IBD in patients on maintenance therapy for their disease were assessed. We identified 20 IBD patients including 13 ulcerative colitis (UC) and 7 Crohn's disease (CD) patients with a mean age of 54.0 ± 10.5years, BMI of 50.1 ± 9.0kg/m(2), and duration of IBD of 11.3 ± 5.2years. Eleven patients were on medication for IBD at baseline. Bariatric procedures included sleeve gastrectomy (N = 9), gastric bypass (N = 7), gastric banding (N = 3), and one conversion of band to gastric bypass. There were no intraoperative complications, but two conversions to laparotomy due to adhesions. Mean BMI change and excess weight loss at 1year was 14.3 ± 5.7kg/m(2) and 58.9 ± 21.1%, respectively. Seven early postoperative complications occurred including dehydration (N = 5), pulmonary embolism (N = 1), and wound infection (N = 1). During a mean follow-up of 34.6 ± 21.7months, five patients developed complications including pancreatitis (N = 2), ventral hernia (N = 2), and marginal ulcer (N = 1). Nine out of ten eligible patients experienced improvement in their IBD status. Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.

Efficacy of Bariatric Surgery in Type 2 Diabetes Mellitus Remission: the Role of Mini Gastric Bypass/One Anastomosis Gastric Bypass and Sleeve Gastrectomy at 1 Year of Follow-up. A European survey.

A retrospective study was undertaken to define the efficacy of both mini gastric bypass or one anastomosis gastric bypass (MGB/OAGB) and sleeve gastrectomy (SG) in type 2 diabetes mellitus (T2DM) remission in morbidly obese patients (pts). Eight European centers were involved in this survey. T2DM was preoperatively diagnosed in 313/3252 pts (9.62%). In 175/313 patients, 55.9% underwent MGB/OAGB, while in 138/313 patients, 44.1% received SG between January 2006 and December 2014. Two hundred six out of 313 (63.7 %) pts reached 1 year of follow-up. The mean body mass index (BMI) for MGB/OAGB pts was 33.1 ± 6.6, and the mean BMI for SG pts was 35.9 ± 5.9 (p < 0.001). Eighty-two out of 96 (85.4%) MGB/OAGB pts vs. 67/110 (60.9%) SG pts are in remission (p < 0.001). No correlation was found in the % change vs. baseline values for hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) in relation to BMI reduction, for both MGB/OAGB or SG (ΔFPG 0.7 and ΔHbA1c 0.4 for MGB/OAGB; ΔFPG 0.7 and ΔHbA1c 0.1 for SG). At multivariate analysis, high baseline HbA1c [odds ratio (OR) = 0.623, 95% confidence interval (CI) 0.419-0.925, p = 0.01], preoperative consumption of insulin or oral antidiabetic agents (OR = 0.256, 95% CI 0.137-0.478, p = <0.001), and T2DM duration >10 years (OR = 0.752, 95% CI 0.512-0.976, p = 0.01) were negative predictors whereas MGB/OAGB resulted as a positive predictor (OR = 3.888, 95% CI 1.654-9.143, p = 0.002) of diabetes remission. A significant BMI decrease and T2DM remission unrelated from weight loss were recorded for both procedures if compared to baseline values. At univariate and multivariate analyses, MGB/OAGB seems to outperform significantly SG. Four independent variables able to influence T2DM remission at 12 months have been identified.

Gastrointestinal traits: individualizing therapy for obesity with drugs and devices

The aims of this article were to review the discrepancy between numbers of people requiring weight loss treatment and results and to assess the potential effects of pharmacologic treatments (recently approved for obesity) and endoscopically deployed devices on quantitative GI traits in development for obesity treatment. We conducted a review of relevant literature to achieve our objectives. The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9%(116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss about 5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These GI and behavioral traits identify sub-phenotypes of obesity, based on recent research. The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative GI and behavioral traits measured in obese patients.

Super-Obesity in the Elderly: Is Bariatric Surgery Justified?

Although the prevalence of obese elderly patients is increasing, the outcomes of bariatric surgery in this potentially high-risk cohort remain poorly understood, especially those relating to quality of life. Furthermore, there is no data on the efficacy of bariatric surgery in the super-obese elderly. We identified 50 consecutive patients undergoing bariatric surgery aged 60 years or over, and compared the outcomes of the super-obese (BMI ≥ 50; n = 26) with those of BMI < 50. Mean follow-up was 33 months. There were no significant differences between the groups in terms of comorbidities, operation-type and peri-operative complications. Mean percentage excess weight loss was comparable between the groups (56.7 vs. 58.8 %; p = 0.81), as was resolution of comorbidities and post-operative quality of life (mean Bariatric Analysis and Reporting Outcome System (BAROS) 3.5 vs. 3.1; p = 0.64).

Improvement in severe pulmonary hypertension in obese patients after laparoscopic gastric bypass or sleeve gastrectomy.

Case reports have suggested that bariatric surgery improves pulmonary hypertension. We performed a retrospective, case-control study to evaluate the safety and efficacy of bariatric surgery in obese patients with severe pulmonary hypertension. Morbidly obese patients followed in a specialty pulmonary hypertension clinic who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2008 and 2013 (n = 10) were compared to a BMI-matched cohort managed with maximal medical therapy (n = 10). Patients with advanced malignancy, prior heart/lung transplantation, and pulmonary hypertension from thromboembolism were excluded. Primary outcomes assessed were changes in use of pulmonary vasodilatory and diuretic medications, need for home oxygen therapy, and mean pulmonary arterial pressures. Secondary outcomes measured were excess body weight loss, perioperative mortality and morbidity, and hospital length of stay. More patients who underwent bariatric surgery experienced improvements in pulmonary arterial pressures (75 vs. 0%, p = 0.02), reduction in or discontinuation of pulmonary vasodilatory therapy (67 vs. 0%, p = 0.01), and decreased diuretic requirements (86 vs. 13%, p = 0.01) than the control cohort. Seventy-five percent of patients previously on home oxygen discontinued therapy after surgery, while oxygen requirements increased in 50% of the control cohort. Excess body weight loss was greater in the surgical group (EWL 68 vs. 19%, p < 0.001). Seven significant complications in five patients occurred in the first postoperative year, but there were no mortalities. Mean inpatient length of stay was 5 days. Laparoscopic gastric bypass and sleeve gastrectomy in obese patients improves pulmonary hypertension in the short term.

Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60.

The proportion of population older than 60 years is rapidly increasing. The majority of this older population suffers from multiple comorbid conditions including obesity. Non-surgical means of weight loss do not offer a predictable solution. Surgical interventions seem to be the most promising solution for the obesity problem, but there is a relative lack of data in literature regarding bariatric procedures in older populations. Our study aims to evaluate the safety and efficacy of bariatric surgery in patients older than 60 years of age, to determine the weight loss, rate of operation-related complications, and impacts of surgery on comorbid conditions, and to compare the effectiveness of bariatric surgery in older patients to the effectiveness of bariatric surgery for the general population at Montefiore Medical Center. A retrospective review of patients' medical records were used to collect data to create databases to identify patients older than 60 years age who underwent bariatric surgery procedures spanning a 4-year period between January 2009 and October 2013. Data reviewed included age, sex, height, pre-operative weight, and body mass index (BMI), presence of obesity-related comorbid conditions, procedures performed, mortality, immediate or delayed complications, length of follow-up, excess weight lost, BMI points lost, percent of excess weight loss (%EWL), hemoglobin Alc (HgbA1c), and effects on obesity-related comorbid conditions. The percent of excess weight loss and number of complications within the older patient group were compared to the general population, which consists of patients between the ages of 22 and 59. Ninety-eight patients were identified. Seven patients did not follow up at any time period, and the eight patients who had laparoscopic adjustable gastric band (LAGB) were also excluded due to insufficient data. Overall, 83 patients who were above the age of 60 were examined; 30 patients had laparoscopic sleeve gastrectomy (LSG), and 53 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The average patient age was 63.4 years, the average pre-operative weight was 122.3 kg, and the average excess body weight was 54.8 kg. The pre-existing comorbid conditions included 90.4 % hypertension (HTN), 63.9 % diabetes mellitus (DM), 50.6 % hyperlipidemia (HL), 34.9 % obstructive sleep apnea (OSA), and 30.1 % asthma. The average %EWL at 3 months, 6 months, and 12 months was 37.0, 51.3, and 65.2 %, respectively. A significant proportion of patients reported resolution or improvement in comorbid conditions. When results were compared to the general, population there was no significant difference in the number of complications that occurred within each of the two groups. The difference in %EWL at the 12-month follow-up was not statistically significant between the general population and the older patients, which suggests that both groups lost a similar amount of weight and that bariatric surgery on patients who are above the age of 60 is effective. Bariatric surgery can be safe and effective for patients older than 60 years of age with a low morbidity and mortality; the weight loss and improvement in comorbidities in older patients were clinically significant. When compared to the general population, there was no statistically significant difference in the average %EWL at 12 months or the number of complications due to surgery. Long-term effects of such interventions will need further studies and investigations.

(488) - Bariatric Surgery: A ‘Bridge to Transplant’ for Morbidly Obese Patients With Advanced Heart Failure

In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients. We studied the safety and efficacy of bariatric surgery in obese patients with advanced heart failure.

A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002-2013.

The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults. This review included 15 studies published between 2002 and 2013. Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive. The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.

An updated National Institutes of Health consensus panel on bariatric surgery.

The last time the National Institutes of Health (NIH) convenedaconsensuspanel onbariatric surgery,manyofour currentmedical studentswere still in diapers. At that time, fewer than 10 000 bariatric procedureswere done annually and the most commonly performed bariatric operations were the vertical banded gastroplasty and open Roux-en-Y gastric bypass. The landscape has changed dramatically since then. Bariatric surgery has become one of themost commonly performed general surgery procedures and it is almost exclusively performed laparoscopically, with a good safety profile. Verticalbandedgastroplastyhasbecomeobsoleteandthemost commonlyperformedbariatricprocedure is laparoscopicsleeve gastrectomy, whichwas not even on the radar screen in 1991. Despite all of these changes, decisions about who should receive bariatric surgery are still based on the 1991 NIH consensus panel. Although evidence on the effectiveness of bariatric surgery was limited at that time, the original NIH panel had a substantial impact on decisionmaking and opened the door for the dramatic growth in the field since then. In this issueof JAMASurgery, Courcoulas et al1 present the report from the second NIH consensus panel. It does not appear that the second consensus conference will have nearly the impact of the first. This appears tobebydesign, as thepanel’s chargewas largely to provide a review and summary of existing evidence. Consequently, the report by Courcoulas et al1 providesavery thoroughreviewof thesubstantialevidence insupportof theeffectivenessandefficacyofbariatric surgery,which may have the salutary effect of further legitimizing the field. This report can be used to support and inform coverage decisions to enhance access to bariatric procedures. However, the panel did not provide explicit recommendations on how coverage should change going forward. In particular, the time is ripe for lowering the body mass index (BMI, calculatedasweight inkilogramsdividedbyheight in meters squared) threshold for bariatric surgery. Evidence fromanumber of randomized clinical trials demonstrates the efficacyof bariatric surgery in the remissionof diabetesmellitusandother comorbidconditions forpatientswithclass Iobesity (BMI, 30-35).2-5 While long-term durability data are lacking for patients in this BMI range, the evidence supporting reducing the BMI threshold to 30 (with comorbidities) is substantially higher now than was the evidence for setting that threshold at 35 in 1991. Certainly, as thenewNIHpanel suggests, further studyof the long-termoutcomes of bariatric surgery, especially sleeve gastrectomy, is warranted. And such studies should include medically treatedpatients, particularlywhenexaminingquality of life and other patient-centered outcomes. But the evidence in support of bariatric surgeryvsmedical therapy in the treatmentofmorbidobesity andassociatedconditions is fairly overwhelming. However, we missed this opportunity to leverage the substantial expertise of this panel tomake recommendations about expanding coverage to these additional patients, who would very clearly benefit from it.

Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up

Introduction: The prevalence of obesity is rising progressively, even among elderly patients. Many studies investigated about safety and efficacy of bariatric surgery among aged obese patients. The objective of this review is to assess the benefits relative to risks of weight loss that may be obtained by performing two common bariatric procedures in obese elderly patient. Materials and methods: We retrospectively evaluated 10 morbid obese patients older than 60 years reaching 5 years of follow up who respectively underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Adjustable Gastric Banding (LAGB). Eventual changes in comorbidities, weight loss, EWL% were investigated. Results: Although LSG patients required a longer postoperative hospital stay than LAGB patients (p < 0.001), both procedures have shown to be safe and equally effective for weight loss achievement in elderly patients. Whereas all patients showed comorbidities resolution, no significant difference in weight loss between LAGB group and LSG group was found at 1 year (EWL% p = 0.87; BMI p = 0.32), 3 years (EWL% p = 0.62; BMI p = 0.79) and 5 years (EWL% p = 0.52; BMI p = 0.46) of follow up. Conclusions: Bariatric surgery is safe and effective to reach obesity related comorbidities resolution among elderly obese patients. Both LAGB and LSG determine a weight loss lesser than observed in a standard bariatric population. In this study LSG is significantly less cost effective than LAGB. Larger studies with longer follow up are however needed to evaluate the real impact of bariatric surgery on weight loss, resolution of comorbidities and improvement of quality of life in elderly obese patients.

Bariatric Surgery in Class I Obesity

Class I obesity conveys an increased risk of comorbidities, impairs physical and mental health-related quality of life, and it is associated to an increased psychosocial burden, particularly in women. The need for effective and safe therapies for class I obesity is great and not yet met by nonsurgical approaches. Eligibility to bariatric surgery has been largely based on body mass index (BMI) cut points and limited to patients with more severe obesity levels. However, obese patients belonging to the same BMI class may have very different levels of health, risk, and impact of obesity on quality of life. Individual patients in class I obesity may have a comorbidity burden similar to, or greater than, patients with more severe obesity. Therefore, the denial of bariatric surgery to a patient with class I obesity suffering from a significant obesity-related health burden and not achieving weight control with nonsurgical therapy simply on the basis of the BMI level does not appear to be clinically justified. A clinical decision should be based on a more comprehensive evaluation of the patient's current global health and on a more reliable prediction of future morbidity and mortality. After a careful review of available data about safety and efficacy of bariatric surgery in patients with class I obesity, this panel reached a consensus on ten clinical recommendations.

Metabolic Syndrome Prevalence and Associations in a Bariatric Surgery Cohort from the Longitudinal Assessment of Bariatric Surgery-2 Study

Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes.

Bariatric surgical management of adolescents with morbid obesity

Adolescent obesity continues to be a significant public health issue. To date, there are no medical therapies that provide significant, durable weight loss. Bariatric surgery has been shown in the adult and now the adolescent population to provide a reasonable alternative for weight loss. Recent publications have focused on the revision of the current guidelines for bariatric surgery in adolescents to more closely align with their well-established adult counterparts. These guidelines now introduce the establishment of multidisciplinary teams for the care of this subset of adolescent surgical patients. Numerous manuscripts in the past 2-3 years have demonstrated the overall effectiveness of Roux-en-Y gastric bypass, adjustable gastric banding, and most recently sleeve gastrectomy for both significant weight loss and comorbidity reduction with safety profiles similar to those found in adults. Despite these data, a recently published study showed that the trend for adolescent bariatric surgery has been stagnant over a 6-year period. There is also an ongoing shift in the type of procedure performed for morbid obesity in the United States toward sleeve gastrectomy and away from the adjustable gastric band. With the growing number of morbidly obese adolescents in the United States coupled with the relative ineffectiveness of medical therapy in this group of patients, bariatric surgery consistently provides a means for significant weight loss and the resolution of substantial comorbidities. Its approval is slowly increasing, and the growing fund of knowledge in regard to complication rates and the efficacy of bariatric surgery will ultimately result in its more widespread acceptance.

Is Bariatric Surgery Safe in Cirrhotics?

Is Bariatric Surgery Safe in Cirrhotics?

Attitudes about the safety and efficacy of bariatric surgery among patients with type 2 diabetes and a body mass index of 30–40 kg/m2

BackgroundDespite increasing awareness within the medical community about the benefits of bariatric surgery for type 2 diabetes mellitus (T2DM), little is known about patients’ attitudes toward bariatric surgery as a treatment for T2DM. The objective of this study was to investigate the attitudes of individuals with T2DM and a body mass index of 30 to 40 kg/m2 concerning bariatric surgery for the treatment of T2DM. MethodsPatients identified from the Pennsylvania Integrated Clinical and Administrative Research Database (PICARD) were surveyed about perceptions of the safety profile and efficacy of bariatric surgery as a treatment for obesity and T2DM and their willingness to be randomly assigned to receive a surgical procedure. ResultsA total of 130 individuals of 513 (25.3%) responded. Respondents had a median (interquartile range) age of 58.0 (range 51.0–63.0) years and self-reported body mass index of 32.9 (range 30.9–35.2) kg/m2. Roughly half (66 of 130) were female. Overall, only 20.3% of respondents had positive views of bariatric surgery, with few reporting that it is a safe (14.3%) and effective (28.5%) treatment for T2DM. Less than 20% of respondents were willing to be randomly assigned to undergo a surgical procedure for the treatment of diabetes (16.1%) or obesity (17.5%). ConclusionsFew obese individuals with T2DM who responded to the survey had positive views about bariatric surgery. Patients’ concerns about the procedure’s safety profile and efficacy must be addressed to improve the acceptability of bariatric surgery as well as the feasibility of randomized, controlled trials of bariatric surgery for these individuals.

Drug treatments to restore vascular function and diabesity

Over the last decades, an escalating rate of type 2 diabetes has paralleled an epidemic rise in the prevalence of obesity. Both diabetes and obesity confer an increased risk of cardiovascular comorbidities, including hypertension, coronary artery disease and stroke. Vascular dysfunction, represented by impaired endothelial release of vasodilator substances or defective smooth muscle vasodilator reactivity, is the early stage of the process leading to atherosclerosis and a common finding in patients with diabesity. It is understandable, therefore, that effective treatments for diabesity should restore vascular function to prevent the development of cardiovascular disease. Recent evidence from clinical studies supports the efficacy of incretin-based antidiabetic therapies for vascular protection. Thus, glucose control with either DDP-4 inhibitor or GLP-1 receptor therapies seems associated with favorable effects on vascular function in diabetes and the metabolic syndrome. Another mechanism to counter excess plasma glucose and reduce body weight in these patients may rely on drug therapies targeting gut hormones, as suggested by the efficacy of bariatric surgery to produce both sustained weight loss and high diabetes remission rates. Also, as knowledge of the multifaceted vascular actions of adipokines and their dysregulation in patients with diabesity increases, these substances become attractive targets for treatments aimed at cardiovascular prevention. The increasing coexistence of diabetes and obesity presents complex treatment challenges owing to the elevated risk of developing cardiovascular complications. Hence, therapeutic strategies integrating glycemic control, weight loss and vascular protection are of the greatest importance to successfully counteract the health and economic burden posed by diabesity.

Bariatric Surgery in Hypothalamic Obesity

Craniopharyngiomas (CP) are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb), is often severe and refractory to therapy. Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven effective in the treatment of HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP–HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be defined. To date, the existing literature on bariatric surgery in CP–HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP–HyOb. We also compare these results to those reported for other populations of HyOb, including Prader–Willi Syndrome, Bardet–Biedl syndrome, and hypothalamic melanocortin signaling defects. While initial reports of bariatric surgery in CP–HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP–HyOb. There continues to be a need for more robust, controlled, prospective studies with long term follow-up in order to better define the role of bariatric surgery in the treatment of HyOb.

Diabetic and bariatric surgery: A review of the recent trends

Bariatric surgery is currently the most effective treatment for diabetes associated with morbid obesity. A Pubmed search was made for all articles on bariatric surgery and diabetes from 2009 to present (March 2011) in order to identify the recent advances in this field. Herein we review the recent data available on the long-term effects of bariatric surgery on diabetes. We also review the efficacy of gastrointestinal surgery done for diabetic patients having body mass index (BMI) <35 kg/m(2) and also the effect of novel bariatric procedures on diabetes associated with obesity. Finally, the efficacy of bariatric surgery in adolescent diabetes and the recent epidemiological trends of type 2 diabetes are also dealt with briefly. RYGB and biliopancreatic diversion (BPD) are effective surgical options for diabetes in the long term (>5 yrs). The efficacy of sleeve gastrectomy on diabetes in the long term is not yet known. Gastrointestinal procedures for non morbidly obese and non obese patients have shown great promise as surgical optional for diabetes, though their efficacy and safety in the long term are unknown. Novel endoscopic techniques and TANTALUS have shown some promise in resolving diabetes in obese patients. Bariatric surgery is very effective is resolving adolescent diabetes.

The Growing Role of Bariatric Surgery in the Management of Type 2 Diabetes: Evidences and Open Questions

The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels.

SFR-117 Safety and efficacy of bariatric surgery in class I obese patients

SFR-117 Safety and efficacy of bariatric surgery in class I obese patients