Mean Percentage Of Excess Weight Loss Research Articles

Laparoscopic Roux-en-Y Gastric Bypass as a Revision Procedure after Restrictive Bariatric Surgery

Adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG) have been extensively used to treat morbid obesity. Patients with insufficient weight loss or complications may require surgical revision. The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is one of the most common procedures currently used for revision. The aim of the study was to analyze surgical outcomes of 30 consecutive patients who underwent revision to LRYGBP in a 2-year period. The prospectively constructed database and the medical records of all patients undergoing revision to LRYGBP were reviewed. Demographics, surgical details, results, and complications were analyzed. There were 23 women and seven men with a mean age of 41.1+/-9.7 years (r=25-61). Mean body mass index (BMI) was 40.0+/-7.5 kg/m(2) (r=27.2-65.2). Initial operation was AGB in 24, VBG in five, and both in one patient. In ten patients, the band had been removed before revision, in 13 cases, band removal and LRYGBP were performed in one surgical intervention, and in two patients, it was performed in a two-step surgery. There were two conversions to open surgery. Five patients presented major surgical complications. Hospital stay averaged 5.1 days (r=3-25). Mean percent excess body weight loss at 6 and 12 months was 61.7+/-27.5 and 81.2+/-20.5 kg/m(2), respectively. Mean percent low body mass index at 6 and 12 months was 22.5+/-9.1 and 29.1+/-11.4 kg/m(2), respectively. LRYGBP as a revision procedure is feasible in most patients. Surgical complications are more frequent.

Long-term Efficacy of a Low-pressure Adjustable Gastric Band in the Treatment of Morbid Obesity

To determine the long-term efficacy and safety of a low-pressure adjustable gastric band in the treatment for morbid obesity and to detect whether age, gender, or preoperative body mass index (BMI) has an impact on the outcome. It is well known that low-pressure adjustable gastric bands such as the Swedish adjustable gastric bands (SAGB) lead to weight loss. However, very few long-term studies have been published and questions remain regarding long-term efficacy and safety, and whether any of the patient's demographic parameters including age, gender, or initial BMI impact the long-term outcome. Six hundred consecutive patients who had a SAGB inserted between August 1996 and October 2005 were evaluated with regard to their initial BMI, age, and sex. There were 488 females and 112 males, with mean age 45.3 +/- 9.1, mean BMI 42.9 +/- 7.2 kg/m2, and mean weight 119.6 +/- 23.9 kg. Overall morbidity was 25.7% (10.4% perioperative, whereas 15.3% on long term). The following data represents 2, 3, 5, and 7 years of follow-up respectively. Mean BMI decreased to 30.9, 30.5, 32.7, and 31.2 kg/m2, whereas mean percentage excess weight loss (%EWL) was 60.5%, 61.5%, 53.2%, and 61.2%. Patients with BMI (<40 kg/m2) lost 63.7%, 61.2%, 45.5%, and 66.1% of their excess weight, whereas patients with BMI (40-49.9 kg/m2) lost 60.1%, 61.3%, 59.4%, and 66.6%, patients with BMI (50-50.9 kg/m2) lost 57.5%, 67.5%, 49.3%, and 40.2%, and patients with BMI (>60 kg/m2) lost 42.2%, 46.3%, 38.7%, and 40.2%. Female patients %EWL were 62.2%, 62.1%, 55.1%, and 62.3%, whereas male %EWL were 54.1%, 59.1%, 42.1%, and 51.3%. Patients <40 years %EWL were 61.8%, 62.5%, 57.1%, and 86.2%, whereas >40 years %EWL were 60.1%, 61.2%, 52.4%, and 60.1%. The SAGB is effective in achieving long-term sustainable weight loss with an acceptably low complication rate. Bands are effective regardless of patients' age and gender. Furthermore, preoperative BMI up to 60 kg/m2 does not influence the outcome.

Efficacy of a low-pressure laparoscopic adjustable gastric band for morbid obesity: patients at long term in a multidisciplinary center

Background Obesity is an increasingly common condition with serious associated morbidity and decreased life expectancy. Laparoscopic adjustable gastric banding (LAGB) has demonstrated its safety and efficacy as a surgical therapy for morbid obesity over the short term. The current study sought to determine the long-term safety and efficacy of a low-pressure LAGB. Methods Between August 1996 and July 2007, 1,000 consecutive patients underwent LAGB implantation with the Swedish Adjustable Gastric Band (SAGB). This series was retrospectively reviewed with regard to weight loss and morbidity. Patients served as their own controls. Results Preoperatively, there were 808 women (81.0%) and 192 men (19.0%) with a mean age of 46 ± 11 years (range 13–81 yrs) and mean body mass index (BMI) of 42.0 ± 7.0 kg/m 2 (range 27–82 kg/m 2). At 1-, 3-, 6-, and 8-year follow-up, mean percent excess weight loss was 41% (n = 600), 56% (n = 367), 51% (n = 114), and 52% (n = 43), respectively. At the same time points, BMI decreased, from 42.0 to 31.0, 32.5, and 30.5 kg/m 2, respectively. Complications occurred in 197 patients. There were 2 operative complications (i.e., stomach perforation and vascular injury) and 25 conversions (2.4%) to open surgery. Major and minor wound infection in the perioperative period occurred in 47 (4.7%) and 43 (4.3%) patients, respectively. There was 1 death from a myocardial infarct 1 week after surgery. Long term, there were 30 (3.0%) band slippages, 31 (3.1%) erosions, 67 (6.7%) port problems, and 12 (1.2%) incisional hernias. Conclusion LAGB with the SAGB is effective in achieving a mean sustainable weight loss of >50% at 8 years after surgery, with an acceptably low morbidity.

Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients

We present a case of a morbidly obese patient with previous laparoscopic Nissen fundoplication (LNF) who was successfully treated by revision to a laparoscopic Roux-en-Y gastric bypass (RYGB) and discuss our collective experience. Between June 2000 and April 2006 seven morbidly obese patients with mean body mass index (BMI) of 39.4 kg/m(2) underwent laparoscopic revision of LNF to RYGB by our group. Important steps of the revision include lysis of all adhesions between the liver and the stomach, dissection of the diaphragmatic crura and gastroesophageal fat pad, reduction and repair of hiatal hernia and complete take-down of the wrap to avoid stapling over the fundoplication which can create an obstructed, septated pouch. There was one (14.3%) conversion. Mean operative time (OT) was 324 (206-419) minutes and length of stay was 4.9 (3-8) days. Early complications occurred in 3/7 (42.9%) patients including a staple line hemorrhage without a need for re-exploration, a small pulmonary embolism without hemodynamic instability and a small-bowel obstruction due to a pre-existing incisional ventral hernia that was not repaired on original operation. There were no anastomotic leaks or deaths. At a mean follow-up of 32.9 (12-39) months, mean percentage excess weight loss was 79.5% and 18/28 (64.3%) comorbid conditions were improved or resolved. Gastroesophageal reflux disease (GERD) evaluation with the GERD health-related quality of life (GERD-HRQL) scale showed a significant reduction of GERD scores postoperatively (16.7 versus 4.4). Although laparoscopic RYGB after antireflux surgery is technically difficult and carries higher morbidity, it is feasible and effective in the treatment of recurrent GERD in morbidly obese patients.

Intraband Pressure Measurements Describe a Pattern of Weight Loss for Patients with Adjustable Gastric Bands

Individuals with adjustable gastric bands experience plateaus in weight loss. Patients commonly attribute this to a "loosening" of their band with time. We sought to elucidate a physiologic mechanism for this pattern in patient behavior and describe the feasibility of a pressure-based adjustment algorithm for adjustable gastric bands. Following IRB protocol, 100 consecutive patients undergoing placement of the Lap-Band (Inamed) were enrolled and followed prospectively for 12 months. Intraband pressure measurements at band volumes 0 to 4 mL were recorded intraoperatively and at each subsequent band adjustment. Band adjustments were made using the currently accepted volume-based postoperative protocol. Seventy-nine patients were included in analysis. Mean percent excess weight loss for the study cohort was 36 +/- 17% at a median followup of 347 days. During the time between adjustments, there was a statistically significant decrease (p < 0.001) in intraband pressure without a corresponding decrease in band volume. This was a result of a substantial change in the pressure-volume relationship of the Lap-Band. As time progressed, the Lap-Band developed less intraband pressure per unit volume. This change was not a result of changes in the elastic properties of the band material itself. Between adjustments, Lap-Band patients experience gradual loss of satiety and a loosening of their band, despite stable band volume. Their experience is substantiated by degradation in their intraband pressures with time. We have demonstrated that intraband pressures correlate with the patient's clinical history and have thereby established the foundation for a pressure-based adjustment protocol.

Early Results with a New Telemetrically Adjustable Gastric Banding

It has already been demonstrated that laparoscopic adjustable gastric banding (LAGB) is a safe and effective alternative to other permanent bariatric surgery techniques. Although clinical complications have been managed through improvements in surgical techniques, port-related complications and adjustment process inefficiencies have persisted. To reduce and manage these issues, a new type of gastric band has been developed which uses telemetric technology to eliminate the use of hydraulic ports and simplify the overall gastric band adjustment procedure. From June 2005 to October 2005, 37 patients were implanted in two German academic centers with the Easyband telemetrically adjustable gastric band (Endoart S.A., Lausanne, Switzerland), using standard gastric banding laparoscopic technique. Prospective data was collected and analyzed for a minimum of 6 months on all morbidly obese patients who underwent laparoscopic telemetrically adjustable gastric banding. Data on 37 patients was analyzed. The mean percent excess weight loss was 10.2% at 1 month, 21.6% at 3 months, and 29.4% at 6 months. In 12 hypertensive patients, the systolic blood pressure decreased from 143 +/- 24 mmHg at baseline to 131 +/- 10 mmHg after 6 months. Diastolic pressure did not change significantly. In all 5 patients with diagnosed type 2 diabetes, the fasting blood glucose normalized after 6 months (135 mg/dl at baseline, 81 mg/dl at month 6). These early results of the new telemetrically adjustable gastric banding device indicate clinical safety and efficacy comparable to that achieved by other commercially available gastric bands. Additional multi-center studies with long-term follow-up are recommended to confirm the benefits of telemetrically adjustable gastric banding.

Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass

In the United States, the most frequently performed bariatric procedure is the Roux-en-Y gastric bypass (RYGB). Worldwide, the most common operation performed is the laparoscopic adjustable gastric band (LAGB). The expanding use of LAGB is probably driven by the encouraging data on its safety and effectiveness, in contrast to the disappointing morbidity and mortality rates reported for RYGB. The aim of this study was to evaluate the results of LAGB versus RYGB at a single institution. Between November 2000 and July 2004, 590 bariatric procedures were performed. Of these, 120 patients (20%) had laparoscopic RYGB and 470 patients (80%) had LAGB. A retrospective review was performed. In the LAGB group, 376 patients (80%) were female, and the mean age was 41 years (range, 17-65). In the RYGB group, 110 patients (91%) were female, and the mean age was 41 years (range, 20-61). Preoperative body mass index was 47 +/- 8 and 46 +/- 5, respectively (p = not significant). Operative time and hospitalization were significantly shorter in LAGB patients (p < 0.001). Complications and the need for reoperation were comparable in both groups. Weight loss at 12, 18, 24, and 36 months for LAGB and RYGB was 39 +/- 21 versus 65 +/- 13, 39 +/- 20 versus 62 +/- 17, 45 +/- 25 versus 67 +/- 8, and 55 +/- 20 versus 63 +/- 9, respectively. The current study demonstrates that LAGB is a simpler, less invasive, and safer procedure than RYGB. Although mean percentage excess body weight loss (%EBWL) in RYGB patients increased rapidly during the first postoperative year, it remained nearly unchanged at 3 years. In contrast, in LAGB patients weight loss was slower but steady, achieving satisfactory %EBWL at 3 years. Therefore, we believe that LAGB should be considered the initial approach since it is safer than RYGB and is very effective at achieving weight loss.

What Becomes of Patients One Year after the Intragastric Balloon has been Removed?

The BioEnterics Intragastric Balloon (BIB) is a saline-filled balloon recommended to remain in the gastric cavity for a maximum of 6 months. Is this short period sufficient to change patients' lifestyle and eating practices to maintain weight reduction after BIB removal? 100 patients who received a BIB were included in this prospective study and followed for 1 year after BIB removal. The post-implantation follow-up visits took place monthly, during which the patient was seen by the surgeon, dietitian, and if necessary, psychologist. At BIB removal, mean weight loss for the group was 12.0 kg. Mean percent excess weight loss (%EWL) was 39.8%. 12 months after removal of the BIB, mean weight loss was 8.6 kg and mean %EWL was 26.8% for the group as a whole. The results 1 year after removal of the BIB were encouraging. Because the BIB is a temporary non-surgical and non-pharmaceutical treatment for obesity that is reversible and repeatable, we recommend it to patients who have previously failed traditional methods of weight reduction. Careful patient follow-up is of primary importance in avoiding complications and supporting efficacy of the treatment. Although 1 year follow-up cannot be considered long term, these results are encouraging. Concurrent behavior modification is needed for durable weight loss.

Laparoscopic Roux-en-Y Gastric Bypass is Safe and Effective in Patients with a BMI ≥60

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been shown to be safe and effective. There is little data on the outcomes in massively super-obese patients, with a body mass index (BMI) > or =60 kg/m2 (super-super-obese). The goal of this study was to determine the safety and effectiveness of LRYGBP in these patients, and compare these results to patients with a BMI <60. 213 consecutive patients undergoing LRYGBP by a single surgeon at a university hospital were included in the study. The patients were divided into 2 groups: BMI <60 kg/m2 (n=167) and BMI > or =60 kg/m2 (n=46). The 2 groups were compared with regard to perioperative complications, and postoperative weight loss. Both groups had statistically similar complication rates. There were major complications in 8 patients (5%) in the lower BMI group and in 3 patients (7%) in the higher BMI group. There were minor complications in 9 patients (5%) in the lower BMI group and in 4 patients (9%) in the higher BMI group. Mean percent excess weight loss (%EWL) was 64% at 1 year in the BMI <60 group and 53% in the BMI > or =60 group. LRYGBP can be performed safely and effectively in super-super-obese patients (BMI > or =60). Although these patients have less %EWL than lighter patients, they still end up with a good result. Therefore, LRYGBP should be considered a good surgical option even for patients with a BMI > or =60.

Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients

Background Performance of bariatric surgery in patients with human immunodeficiency virus (HIV) infection is controversial. The advent of highly active antiretroviral treatment (HAART) has dramatically reduced the progression of HIV/AIDS, so that these individuals live longer, with nearly undetectable viral loads, and thus may develop obesity and similar obesity-related comorbidity as occurs in the general population. However, HAART also causes lipodystrophy, placing these patients at increased risk for coronary artery disease. Methods This was a retrospective study of 6 patients from a prospectively maintained database of 892 patients (0.71%) undergoing bariatric surgery between June 1999 and December 2003. Results Six HIV-infected patients (4 women, 2 men; mean age, 43 years [range, 28–56 years]; mean preoperative weight, 142 kg [range, 110–174 kg]; mean preoperative body mass index, 50 [range, 42–59) underwent Roux-en-Y gastric bypass (RYGB). The mean duration of HIV infection was 9 years; 33% were receiving HAART at the time of surgery, which was discontinued perioperatively for 2–3 days. Average CD4 cell count was 619 cells/mm 3 (range, 361–1096 cells/mm 3). Preoperative comorbidities included type 2 diabetes mellitus/impaired gluccose tolerance (3 cases), hypertension (2 cases), dyslipidemia (2 cases), coronary artery disease/chronic heart failure (1 case), sleep apnea (4 cases), asthma (2 cases), gastroesophageal reflux disease (3 cases), arthritis (5 cases), and depression (3 cases). Average preoperative length of hospital stay was 4.2 days (range, 3–5 days). There were no deaths or postoperative infectious complications. Mean percent excess body weight loss was 33% at 3 months, 47% at 6 months, and 61% at 12 months. Mean percent initial body weight lost was 19% at 3 months, 26% at 6 months, and 33% at 12 months. Conclusion RYGB can be safely performed in HIV-infected individuals. Initial results appear to be comparable to those in noninfected controls. Well-controlled HIV infection should not be an absolute contraindication to bariatric surgery.

Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure

Background Obesity and its related illness is a primary health concern today. Methods Five hundred morbidly obese patients (mean age 42 years; mean preoperative weight 123 kg) underwent laparoscopic adjustable gastric banding surgery in a private U.S. hospital setting within a comprehensive multidisciplinary bariatric program. Patients were followed up to 36 months. Comorbidity status was assessed for 163 patients who completed ≥18 months’ follow-up by comparing medications (type and dosage) prescribed for each comorbid condition before surgery and at follow-up. Results At 36 months after surgery, mean body mass index (BMI) had decreased from 45.2 to 34.9 kg/m 2 and mean percent excess weight loss (%EWL) was 47%. Complications were as follows: gastric pouch dilatation (6.8%), slippage (2.8%), and stoma obstruction (0.6%). There was no mortality. Resolution or improvement of comorbidities were as follows: gastroesophageal reflux disease (GERD) (87%; usually immediately postsurgery), asthma (81.8%), diabetes (66%), dyslipidemia (65.5%), hypertension (48%), and sleep apnea (33%). Conclusions Gastric banding provides good weight loss and significant reduction in comorbidities with few and minor complications.

Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been very effective in managing a broad range of morbid obesity-related co-morbidities. We report a beneficial effect of LRYGBP that has not been previously observed. Between December 1999 and September 2002, 224 patients underwent LRYGBP. Preoperative assessment for hypothyroidism and follow-up data were prospectively collected in our database. Improved thyroid function (ITF) or unchanged thyroid function (UTF) was determined by comparison of preoperative and postoperative thyroxine requirements. 23 of 224 patients (10.3%) were treated preoperatively for hypothyroidism. During a median follow-up of 17 months, hypothyroidism was improved in 10/23 patients (43.5%). 2 patients had complete resolution, and the remaining 8 had reduction (14%-50%) of their thyroxine requirements. ITF occurred at a mean follow-up of 8.9 months and at a mean excess weight loss (EWL) of 57%. 6 of the 8 patients (75%) with ITF >or= 25% had EWL >90% at last follow-up, compared to 1 out of 15 patients (6.6%) with UTF or <25% improvement (P =0.001). Comparison of patients with ITF and UTF over time during a 20-month follow-up, showed no significant difference in mean body mass index (BMI) and mean percentage of EWL. Improvement of hypothyroidism may be an additional benefit of bariatric surgery that has not been previously reported. Reduction of thyroxine requirements is most likely the result of the decrease in the BMI.

Laparoscopic Roux-en-Y Gastric Bypass: Minimally Invasive Bariatric Surgery for the Superobese in the Community Hospital Setting

Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.

Laparoscopic technique for performing duodenal switch with gastric reduction.

The duodenal switch procedure with gastric reduction (DS) is a hybrid procedure for morbid obesity that combines moderate intake restriction with moderate malabsorption. This report describes the laparoscopic hand-assisted technique for the duodenal switch procedure (LapDS). Restriction is achieved via a greater curvature gastrectomy, reducing gastric capacity to 120 ml. The malabsorptive component is constructed by dividing the duodenum 4 cm distal to the pylorus and anastomosing the proximal duodenum to the distal 250 cm of ileum. The biliopancreatic limb is anastomosed to create a 100 cm common channel. Laparoscopic cholecystectomy, cholangiogram, liver biopsy and appendectomy are performed in conjunction with DS. 345 LapDS procedures (27 lap-assisted; 318 hand-assisted) were performed between September 1999 and February 2002. There were 299 women and 46 men with a mean age of 43 years (range 19-67 years). Mean BMI was 50 (range 36-118 kg/m(2)). Mean operating time was 201 minutes (range 105-480). The median length of hospital stay was 3.0 days (range 2-22 days, excluding one outlier). There were 7 conversions to open laparotomy, 14 reoperations, and 21 readmissions. There were 3 pulmonary emboli, 2 deep venous thromboses, and 4 perioperative proximal anastomotic strictures. There were no deaths. Mean percent excess weight loss at 6, 18, and 24 months was 51%, 89%, and 91%, respectively. Laparoscopic assisted duodenal switch procedure can be performed safely with acceptable operative times and without excess morbidity or mortality.

Open Roux-en-Y gastric bypass for the morbidly obese in the era of laparoscopy

Background:Roux-En-Y gastric bypass (RYGB) has been the preferred operative treatment for morbid obesity. Recently, laparoscopic RYGB has been described. We reviewed our data and believe that open RYGB is still the better option. MethodsOne hundred three consecutive cases were retrospectively reviewed for preoperative conditions, perioperative outcomes, and postoperative complications with weight/health changes. ResultsThe mean follow-up was 5 months. The mean percent excess body weight loss was 33%. Comorbidities improved 50% of the time. The mean operative time was 117 minutes with blood loss averaging 208 cc. The mean intensive care unit stay was 1.3 days, with a total hospital stay of 4.4 days. There was an 8% major complication rate and a 1% mortality rate. ConclusionsThe health improvement and complication rates are comparable to published series on laparoscopic RYGB. With the technical complexity of the laparoscopic technique, open RYGB should remain the current standard of care, in most centers.

Surgical treatment of morbid obesity with biliopancreatic diversion and gastric banding: report on an 8-year experience involving 235 cases

Study aim: Developments have recently been made in bariatric surgery outside the USA. The aim of this retrospective non-randomized study was to report on our experience regarding biliopancreatic diversion (BPD) and non-adjustable gastric banding (GB) in a population of 235 obese patients. Patients and methods: From March 1990 to March 1998, 235 obese patients were operated on, 142 by BDP and 93 by GB, via laparotomy after rigourous selection of the patient population. Results: The mean duration of surgery was 2 h 50 minutes for BPD and 1 h for GB. One postoperative death occurred due to massive pulmonary embolism. Early major complications were frequent in the BPD group ( n = 21) but rare in the GB group ( n = 1). Mean duration of hospitalization was 16 days in the BPD group versus 9 days in the GB group. Mean percentage excess weight loss was 48% for the GB group and 60% for the BPD group after two years. Late mortality was limited to the BPD group (3.5%). Late complications were evenly distributed between the two groups, with a prevalence of malnutrition in the BPD group and outlet stenosis in the GB group. A high incidence of band removal was recorded related to this complication (17.2%). Incisional hernias were present in both groups. Conclusions: GB and BPD are techniques which can induce weight loss and bring about subsequent health benefits. Nevertheless, in a few patients further intervention or adaptation of the approach due to clinical failure or to a high complication rate is required. Additional research is needed regarding determination of the surgical treatment that is best adapted to the case in question, i.e., taking into consideration both the restrictive and malabsorbative aspects.

Preliminary results of the duodenal switch.

The duodenal switch (DS), as a modification of the bilio-pancreatic diversion (BPD), is a 'complex' hybrid operation. Sixty patients were operated on during the last 3 years. Two patients died early (3.3%); two late deaths occurred at 4 and 7 months, one due to liver failure and the other due to malnutrition and refeeding syndrome (3.57%); three patients required conversions (5.3%). The two early deaths and all the patients who required conversions had a previous vertical banded gastroplasty. Eleven patients had minor liver abnormalities corrected with medications, and one patient had severe diarrhea for more than a year. Eleven female patients have iron deficiency anemia that requires parenteral supplementation. Mean percent excess weight loss was 86% at 2.5 years. The DS has been, in our experience, an unsafe operation with unacceptably high operative and postoperative mortality. The conversion rate is acceptable. Weight loss, quality of food intake and life have been excellent. Inadequate follow-up can be dangerous if patients fail to report for regular visits.

Vertical Banded Gastroplasty: Stable Trends in Weight Control at 10 or More Years.

Whether long-term weight loss outcomes will succumb to adaptations in patients after gastric restrictive procedures has yet to be determined. The relationship, if any, of post-operative weight loss and maintenance to follow-up by support group and/or by surgeon, at least long-term, is uncertain. These questions have prompted review of my patients at 10-12 and at 5-10 years after vertical banded gastroplasty (VBG). Of the 118 patients (43 at 10-12 years), 65 were able to be contacted (55%). Successes were defined as patients who at the time of study interview, without operative revision, had lost at least 25% of their pre-operative excess weight. All known revisions (7) are reported as failures; only one of the seven was discovered in the study interviews. The mean body mass index of the entire study group (65) pre-operatively was 49.7, with 32% (21/65) super obese. Patient pre-operative profiles of successes and failures of both interval groups are remarkably similar. Successes were 65% in the >/= 10 year group and 68% in the 5-10 year group. Respectively, mean percent excess weight loss was 46% and 54%. Six (of seven) failures, and ten (of 13) successes, in the >/= 10 year group had 5.5 cm circumference outlets; all patients in the 5-10 year group were at 5.0 cm. Marked reduction in the follow-up pattern in the 5-10 year group failures was not significant but appears predictive. This experience suggests little deterioration in success rate, weight loss among successes, or revision requirement in VBG patients between 5 and > 10 years.

Gastroplasty/Distal Gastric Bypass: An Operation Producing Excellent and Prolonged Weight Loss in the Super-Obese.

Thirty-three super-obese patients underwent gastroplasty/distal gastric bypass. The follow-up was between two and 9.4 years. Mean greatest percentage excess weight loss was 80%, females losing somewhat more weight than males. Mean final percentage excess weight loss was 73%. Chronological analysis of weight loss showed that there was some slight gain of weight over the years. There were no weight loss failures within the group. Pre-operative patients who were hypertensive and diabetic became normal after weight loss. There were no metabolic alterations or deficiencies of note. The Incidence of stomal ulcer was 12% and this was adequately dealt with by vagotomy.

Effect of Surgically Induced Weight Loss on Asthma in the Morbidly Obese.

Forty morbidly obese asthmatic patients who underwent gastric restrictive surgery more than 2 years earlier were evaluated to determine the influence of weight loss on asthma outcome. Mean percentage excess weight loss in this group was 68% and body mass index (BMI) fell from a mean of 46 to 30. Following surgery, 90% showed improvement in asthma symptoms. Complete remission of asthma occurred in 48% and a further 12.5% became asthma free on reduced medications dosage. Of those taking daily medications for asthma before surgery, 42% were completely off medication following weight loss surgery, and another 18.5% experienced fewer asthma attacks on reduced medication dosage. Of the 22 patients with severe asthma (> 10 attacks per year) on routine daily medications for asthma preoperatively, 8(36%) required no medication after surgery, 7(32%) used medication only on an 'as-needed' basis, and 7(32%) controlled their asthma on reduced medication dosage. Five patients gained weight during the follow-up period. All developed an increased incidence of asthma attacks, which again abated after successfully losing weight following revisional surgery. Coexistent factors of smoking and clinically apparent esophageal reflux were evaluated, but no statistically significant correlation was shown with either smoking or reflux and improvement in asthma. Possible etiologies of the improvement in asthma with weight loss are discussed