id
stringlengths 14
28
| title
stringclasses 18
values | content
stringlengths 2
999
| contents
stringlengths 19
1.02k
|
|---|---|---|---|
Surgery_Schwartz_7902 | Surgery_Schwartz | hyper-tension, 73% for T2DM, and 65% for hyperlipidemia. Results from 12 cohort-matched, nonrandomized studies comparing bariatric surgery vs. nonsurgical controls demonstrated reduced cardiovascular events and death (30–88% reduction) in patients with and without T2DM.227 One of these studies involving male veterans, who were mostly at high cardiovascular risk, reported a 42% reduction in mortality at 10 years compared with medical therapy.207 Similarly, in the Swedish Obese Subjects study, the mortality rate from cardiovascular disease in the bariatric surgical group was lower than for control patients (adjusted hazard ratio, 0.47; P = .002).201 For patients with T2DM in this study, surgery was associated with a 50% reduction in microvascular complica-tions (41.8 per 1000 person-years for control patients and 20.6 per 1000 person-years in the surgery group; hazard ratio, 0.44; P <.001).245 These observational, nonrandomized studies provide evidence that metabolic surgery is superior | Surgery_Schwartz. hyper-tension, 73% for T2DM, and 65% for hyperlipidemia. Results from 12 cohort-matched, nonrandomized studies comparing bariatric surgery vs. nonsurgical controls demonstrated reduced cardiovascular events and death (30–88% reduction) in patients with and without T2DM.227 One of these studies involving male veterans, who were mostly at high cardiovascular risk, reported a 42% reduction in mortality at 10 years compared with medical therapy.207 Similarly, in the Swedish Obese Subjects study, the mortality rate from cardiovascular disease in the bariatric surgical group was lower than for control patients (adjusted hazard ratio, 0.47; P = .002).201 For patients with T2DM in this study, surgery was associated with a 50% reduction in microvascular complica-tions (41.8 per 1000 person-years for control patients and 20.6 per 1000 person-years in the surgery group; hazard ratio, 0.44; P <.001).245 These observational, nonrandomized studies provide evidence that metabolic surgery is superior |
Surgery_Schwartz_7903 | Surgery_Schwartz | control patients and 20.6 per 1000 person-years in the surgery group; hazard ratio, 0.44; P <.001).245 These observational, nonrandomized studies provide evidence that metabolic surgery is superior to medical manage-ment alone in improving glycemic control, reducing cardiovascu-lar risk factors, and lowering long-term morbidity and mortality of T2DM, yet supporting RCTs have been lacking until recently.During the past 10 years, 11 such RCTs have been published including 794 patients in total (Table 27-7).16,77-83,85,86,246-253 These RCTs included obese patients with T2DM (n = 794; range 38–150 patients per study) with follow-up from 6 months to 5 years (Fig. 27-27). All common metabolic surgical procedures were represented including LRYGB (9 studies), LAGB (5 studies), SG (2 studies), and BPD (1 study). T2DM severity varied significantly from mild (mean HbA1c 7.7%, <2-year onset, no insulin)253,77 to severe (mean HbA1c 9.3%, duration 8.3 years, 48% on insulin).78 The BMI ranged from | Surgery_Schwartz. control patients and 20.6 per 1000 person-years in the surgery group; hazard ratio, 0.44; P <.001).245 These observational, nonrandomized studies provide evidence that metabolic surgery is superior to medical manage-ment alone in improving glycemic control, reducing cardiovascu-lar risk factors, and lowering long-term morbidity and mortality of T2DM, yet supporting RCTs have been lacking until recently.During the past 10 years, 11 such RCTs have been published including 794 patients in total (Table 27-7).16,77-83,85,86,246-253 These RCTs included obese patients with T2DM (n = 794; range 38–150 patients per study) with follow-up from 6 months to 5 years (Fig. 27-27). All common metabolic surgical procedures were represented including LRYGB (9 studies), LAGB (5 studies), SG (2 studies), and BPD (1 study). T2DM severity varied significantly from mild (mean HbA1c 7.7%, <2-year onset, no insulin)253,77 to severe (mean HbA1c 9.3%, duration 8.3 years, 48% on insulin).78 The BMI ranged from |
Surgery_Schwartz_7904 | Surgery_Schwartz | BPD (1 study). T2DM severity varied significantly from mild (mean HbA1c 7.7%, <2-year onset, no insulin)253,77 to severe (mean HbA1c 9.3%, duration 8.3 years, 48% on insulin).78 The BMI ranged from 25 to 53 kg/m2, with 11 of 12 studies including patients with BMI <35 kg/m2, also called class 1 obesity. Age, sex, and ethnic background were similar, 7Brunicardi_Ch27_p1167-p1218.indd 120023/02/19 2:21 PM 1201THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Table 27-7Metabolic surgery randomized controlled trials for type 2 diabetes (n = 794)aSTUDYBMI (kg/m2), % OF PATIENTSDESIGNNO. OF PATIENTS RANDOMIZEDFOLLOW-UP (MONTHS)REMISSION CRITERIA*OUTCOME (REMISSION OR CHANGE IN HbA1C)Dixon77<35, 22%LAGB vs. control6024HbA1c <6.2%73% vs. 13%, P <0.001Schauer78,246,252<35, 36%RYGB vs. SG vs. control15060HbA1c ≤6.0%22% vs. 15% vs. 0, P<0.05Mingrone79,82>35, 100%RYGB vs. BPD vs. control6060HbA1c ≤6.5%42% vs. 68% vs. 0, P = 0.003Ikramuddin 80,247<35, 59%RYGB vs. control12024HbA1c <6%44% vs. 9%, | Surgery_Schwartz. BPD (1 study). T2DM severity varied significantly from mild (mean HbA1c 7.7%, <2-year onset, no insulin)253,77 to severe (mean HbA1c 9.3%, duration 8.3 years, 48% on insulin).78 The BMI ranged from 25 to 53 kg/m2, with 11 of 12 studies including patients with BMI <35 kg/m2, also called class 1 obesity. Age, sex, and ethnic background were similar, 7Brunicardi_Ch27_p1167-p1218.indd 120023/02/19 2:21 PM 1201THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Table 27-7Metabolic surgery randomized controlled trials for type 2 diabetes (n = 794)aSTUDYBMI (kg/m2), % OF PATIENTSDESIGNNO. OF PATIENTS RANDOMIZEDFOLLOW-UP (MONTHS)REMISSION CRITERIA*OUTCOME (REMISSION OR CHANGE IN HbA1C)Dixon77<35, 22%LAGB vs. control6024HbA1c <6.2%73% vs. 13%, P <0.001Schauer78,246,252<35, 36%RYGB vs. SG vs. control15060HbA1c ≤6.0%22% vs. 15% vs. 0, P<0.05Mingrone79,82>35, 100%RYGB vs. BPD vs. control6060HbA1c ≤6.5%42% vs. 68% vs. 0, P = 0.003Ikramuddin 80,247<35, 59%RYGB vs. control12024HbA1c <6%44% vs. 9%, |
Surgery_Schwartz_7905 | Surgery_Schwartz | ≤6.0%22% vs. 15% vs. 0, P<0.05Mingrone79,82>35, 100%RYGB vs. BPD vs. control6060HbA1c ≤6.5%42% vs. 68% vs. 0, P = 0.003Ikramuddin 80,247<35, 59%RYGB vs. control12024HbA1c <6%44% vs. 9%, P <0.001Liang248<35, 100%RYGB vs. control10112HbA1c <6.5%**90% vs. 0 vs. 0, P <0.0001Halperin83<35, 34%RYGB vs. control3812HbA1c <6.5%58% vs. 16%, P = 0.03Courcoulas84,86<35, 43%RYGB vs. LAGB vs. control6936HbA1c <6.5%40% vs. 29% vs. 0, P = 0.004Wentworth250≤30, 100%LAGB vs. control5124Fasting blood glucose <7.0 mmol/L52% vs. 8%, P = 0.001Parikh251<35, 100%Bariatric surgery (RYGB, LAGB, SG) vs. control576HbA1c <6.5%65% vs. 0, P = 0.0001Ding85<35, 34%LAGB vs. control4512HbA1c <6.5%***33% vs. 23%, P = 0.46Cummings81<35, 25%RYGB vs. control4312HbA1c <6.0%60% vs. 5.9%, P = 0.002*Remission defined as reaching HbA1c value without medication, unless otherwise specified**Remission not precisely defined, extrapolated***On or off medicationsReproduced with permission from Schauer PR, Mingrone G2, | Surgery_Schwartz. ≤6.0%22% vs. 15% vs. 0, P<0.05Mingrone79,82>35, 100%RYGB vs. BPD vs. control6060HbA1c ≤6.5%42% vs. 68% vs. 0, P = 0.003Ikramuddin 80,247<35, 59%RYGB vs. control12024HbA1c <6%44% vs. 9%, P <0.001Liang248<35, 100%RYGB vs. control10112HbA1c <6.5%**90% vs. 0 vs. 0, P <0.0001Halperin83<35, 34%RYGB vs. control3812HbA1c <6.5%58% vs. 16%, P = 0.03Courcoulas84,86<35, 43%RYGB vs. LAGB vs. control6936HbA1c <6.5%40% vs. 29% vs. 0, P = 0.004Wentworth250≤30, 100%LAGB vs. control5124Fasting blood glucose <7.0 mmol/L52% vs. 8%, P = 0.001Parikh251<35, 100%Bariatric surgery (RYGB, LAGB, SG) vs. control576HbA1c <6.5%65% vs. 0, P = 0.0001Ding85<35, 34%LAGB vs. control4512HbA1c <6.5%***33% vs. 23%, P = 0.46Cummings81<35, 25%RYGB vs. control4312HbA1c <6.0%60% vs. 5.9%, P = 0.002*Remission defined as reaching HbA1c value without medication, unless otherwise specified**Remission not precisely defined, extrapolated***On or off medicationsReproduced with permission from Schauer PR, Mingrone G2, |
Surgery_Schwartz_7906 | Surgery_Schwartz | as reaching HbA1c value without medication, unless otherwise specified**Remission not precisely defined, extrapolated***On or off medicationsReproduced with permission from Schauer PR, Mingrone G2, Ikramuddin S, et al: Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes, Diabetes Care. 2016 Jun;39(6):902-911.although three studies80,247,248 included a significant number of Asian patients. For most studies, the primary endpoint was remission, defined as an HbA1c target at or below 6.0% to 6.5% without use of diabetes medications.Overall, these RCTs showed that surgery was signifi-cantly more effective than medical treatment in reaching remission and glycemic control (P <.05) (Fig. 27-27). The one exception showing no superiority of surgery involved gastric banding and resulted in a diabetes remission for LAGB vs. medical treatment of 33% and 23%, respectively (P >0.05).85 Overall, surgery decreased HbA1c by 2% to 3.5%, whereas | Surgery_Schwartz. as reaching HbA1c value without medication, unless otherwise specified**Remission not precisely defined, extrapolated***On or off medicationsReproduced with permission from Schauer PR, Mingrone G2, Ikramuddin S, et al: Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes, Diabetes Care. 2016 Jun;39(6):902-911.although three studies80,247,248 included a significant number of Asian patients. For most studies, the primary endpoint was remission, defined as an HbA1c target at or below 6.0% to 6.5% without use of diabetes medications.Overall, these RCTs showed that surgery was signifi-cantly more effective than medical treatment in reaching remission and glycemic control (P <.05) (Fig. 27-27). The one exception showing no superiority of surgery involved gastric banding and resulted in a diabetes remission for LAGB vs. medical treatment of 33% and 23%, respectively (P >0.05).85 Overall, surgery decreased HbA1c by 2% to 3.5%, whereas |
Surgery_Schwartz_7907 | Surgery_Schwartz | surgery involved gastric banding and resulted in a diabetes remission for LAGB vs. medical treatment of 33% and 23%, respectively (P >0.05).85 Overall, surgery decreased HbA1c by 2% to 3.5%, whereas medical treatment lowered it by 1% to 1.5%, as seen in Fig. 27-28. Most of these studies also showed superiority of surgery over medical treatment in achieving secondary endpoints such as weight loss, remission of metabolic syn-drome, reduction in diabetes and cardiovascular medications, and improvement in triglycerides, lipids, and quality of life. Results were mixed in terms of improvements in systolic and diastolic blood pressure or low-density lipoproteins after sur-gery vs. medical treatment, but many studies did show a cor-responding reduction in medication usage.Although previous guidelines and payer coverage policies had limited metabolic surgery to severely obese patients (BMI ≥35 kg/m2), nearly all RCTs showed that the surgical procedures, especially LRYGB and SG, were equally | Surgery_Schwartz. surgery involved gastric banding and resulted in a diabetes remission for LAGB vs. medical treatment of 33% and 23%, respectively (P >0.05).85 Overall, surgery decreased HbA1c by 2% to 3.5%, whereas medical treatment lowered it by 1% to 1.5%, as seen in Fig. 27-28. Most of these studies also showed superiority of surgery over medical treatment in achieving secondary endpoints such as weight loss, remission of metabolic syn-drome, reduction in diabetes and cardiovascular medications, and improvement in triglycerides, lipids, and quality of life. Results were mixed in terms of improvements in systolic and diastolic blood pressure or low-density lipoproteins after sur-gery vs. medical treatment, but many studies did show a cor-responding reduction in medication usage.Although previous guidelines and payer coverage policies had limited metabolic surgery to severely obese patients (BMI ≥35 kg/m2), nearly all RCTs showed that the surgical procedures, especially LRYGB and SG, were equally |
Surgery_Schwartz_7908 | Surgery_Schwartz | and payer coverage policies had limited metabolic surgery to severely obese patients (BMI ≥35 kg/m2), nearly all RCTs showed that the surgical procedures, especially LRYGB and SG, were equally effective in patients with BMI 30 to 35 kg/m2. This is particularly important given that many patients with T2DM have a BMI <35 kg/m2. The effect of surgery in these patients with a lower class of obesity is also durable out to at least 5 years.243,252None of these RCTs were sufficiently powered to detect differences in macrovascular or microvascular complications or death, especially at the relatively short follow-up, and no such differences have been detected thus far. Four of the RCTs from Pittsburgh, Seattle, Boston, and Cleveland have combined their patient populations in a pooled study to assess 10-year out-comes. This study, Alliance of Randomized Trials of Medicine vs. Metabolic Surgery (ARMMS), aims to identify long-term risks and benefits of metabolic surgery.The evidence, as | Surgery_Schwartz. and payer coverage policies had limited metabolic surgery to severely obese patients (BMI ≥35 kg/m2), nearly all RCTs showed that the surgical procedures, especially LRYGB and SG, were equally effective in patients with BMI 30 to 35 kg/m2. This is particularly important given that many patients with T2DM have a BMI <35 kg/m2. The effect of surgery in these patients with a lower class of obesity is also durable out to at least 5 years.243,252None of these RCTs were sufficiently powered to detect differences in macrovascular or microvascular complications or death, especially at the relatively short follow-up, and no such differences have been detected thus far. Four of the RCTs from Pittsburgh, Seattle, Boston, and Cleveland have combined their patient populations in a pooled study to assess 10-year out-comes. This study, Alliance of Randomized Trials of Medicine vs. Metabolic Surgery (ARMMS), aims to identify long-term risks and benefits of metabolic surgery.The evidence, as |
Surgery_Schwartz_7909 | Surgery_Schwartz | to assess 10-year out-comes. This study, Alliance of Randomized Trials of Medicine vs. Metabolic Surgery (ARMMS), aims to identify long-term risks and benefits of metabolic surgery.The evidence, as previously summarized, was the basis for newly established international guidelines on the role of metabolic surgery in treating T2DM. In 2015, the 2nd Diabetes Surgery Summit (DSS-II) Consensus Conference generated Brunicardi_Ch27_p1167-p1218.indd 120123/02/19 2:21 PM 1202SPECIFIC CONSIDERATIONSPART IIParikh 2014 (RYGB/LAGB/SG) [6 mo; 6.5% off meds] (18)Courcoulas 2014 (RYGB/LAGB) [12 mo; 6.5% off meds] (14)Ding 2015 (LAGB) [12 mo; 6.5%] (22)Halperin 2014 (RYGB) [12 mo; 6.5% off meds] (15)Ikramuddin 2013 (RYGB) [12 mo; 7.0%] (13)Liang 2013 (RYGB) [12 mo; 7.0% off meds] (16)Schauer 2012 (RYGB/SG) [12 mo; 6.0%] (12)Cummings 2016 (RYGB) [12 mo; 6.5% off meds] (23)Dixon 2008 (LAGB) [24 mo; 6.2% off meds] (10)Ikramuddin 2015 (RYGB) [24 mo; 7.0%] (21)Mingrone 2012 (RYGB/BPD) [24 mo; 6.5% | Surgery_Schwartz. to assess 10-year out-comes. This study, Alliance of Randomized Trials of Medicine vs. Metabolic Surgery (ARMMS), aims to identify long-term risks and benefits of metabolic surgery.The evidence, as previously summarized, was the basis for newly established international guidelines on the role of metabolic surgery in treating T2DM. In 2015, the 2nd Diabetes Surgery Summit (DSS-II) Consensus Conference generated Brunicardi_Ch27_p1167-p1218.indd 120123/02/19 2:21 PM 1202SPECIFIC CONSIDERATIONSPART IIParikh 2014 (RYGB/LAGB/SG) [6 mo; 6.5% off meds] (18)Courcoulas 2014 (RYGB/LAGB) [12 mo; 6.5% off meds] (14)Ding 2015 (LAGB) [12 mo; 6.5%] (22)Halperin 2014 (RYGB) [12 mo; 6.5% off meds] (15)Ikramuddin 2013 (RYGB) [12 mo; 7.0%] (13)Liang 2013 (RYGB) [12 mo; 7.0% off meds] (16)Schauer 2012 (RYGB/SG) [12 mo; 6.0%] (12)Cummings 2016 (RYGB) [12 mo; 6.5% off meds] (23)Dixon 2008 (LAGB) [24 mo; 6.2% off meds] (10)Ikramuddin 2015 (RYGB) [24 mo; 7.0%] (21)Mingrone 2012 (RYGB/BPD) [24 mo; 6.5% |
Surgery_Schwartz_7910 | Surgery_Schwartz | (RYGB/SG) [12 mo; 6.0%] (12)Cummings 2016 (RYGB) [12 mo; 6.5% off meds] (23)Dixon 2008 (LAGB) [24 mo; 6.2% off meds] (10)Ikramuddin 2015 (RYGB) [24 mo; 7.0%] (21)Mingrone 2012 (RYGB/BPD) [24 mo; 6.5% off meds] (11)Wentworth 2014 (LAGB) [24 mo; 7.0%] (17)Courcoulas 2015 (RYGB/LAGB) [36 mo; 6.5% off meds] (24)Schauer 2014 (RYGB/SG) [36 mo; 6.0%] (19)Mingrone 2015 (RYGB/BPD) [60 mo; 6.5% off meds] (20)Fixed-Effects ModelStudy (Operation) [Follow-Up; HbA1c end point]WeightPeto, Fixed, 95% CIPolo Odds Ratios131861128283492226341214271920411819573199152960402337973862400531100148020002417221957704117265920251440154664.5%5.1%3.9%4.4%12.5%8.4%10.4%3.4%6.7%11.8%6.4%4.9%4.0%8.7%4.9%100.0%21.15 [5.85, 76.51]7.51 [2.24, 25.21]1.68 [0.42, 6.66]5.82 [1.59, 21.39]3.72 [1.72, 8.04]86.76 [33.89, 222.08]6.39 [2.74, 14.88]11.48 [2.63, 50.13]10.83 [3 .79, 30.96]4.25 [1.92, 9.38]30.08 [10.28, 88.06]8.11 [2.37, 27.84]6.44 [1.65, 25.21]5.73 [2.28, 14.42]8.44 [2.46, 29.01]8.45 [6.44, 11.10]SurgeryGlyc. Endp. | Surgery_Schwartz. (RYGB/SG) [12 mo; 6.0%] (12)Cummings 2016 (RYGB) [12 mo; 6.5% off meds] (23)Dixon 2008 (LAGB) [24 mo; 6.2% off meds] (10)Ikramuddin 2015 (RYGB) [24 mo; 7.0%] (21)Mingrone 2012 (RYGB/BPD) [24 mo; 6.5% off meds] (11)Wentworth 2014 (LAGB) [24 mo; 7.0%] (17)Courcoulas 2015 (RYGB/LAGB) [36 mo; 6.5% off meds] (24)Schauer 2014 (RYGB/SG) [36 mo; 6.0%] (19)Mingrone 2015 (RYGB/BPD) [60 mo; 6.5% off meds] (20)Fixed-Effects ModelStudy (Operation) [Follow-Up; HbA1c end point]WeightPeto, Fixed, 95% CIPolo Odds Ratios131861128283492226341214271920411819573199152960402337973862400531100148020002417221957704117265920251440154664.5%5.1%3.9%4.4%12.5%8.4%10.4%3.4%6.7%11.8%6.4%4.9%4.0%8.7%4.9%100.0%21.15 [5.85, 76.51]7.51 [2.24, 25.21]1.68 [0.42, 6.66]5.82 [1.59, 21.39]3.72 [1.72, 8.04]86.76 [33.89, 222.08]6.39 [2.74, 14.88]11.48 [2.63, 50.13]10.83 [3 .79, 30.96]4.25 [1.92, 9.38]30.08 [10.28, 88.06]8.11 [2.37, 27.84]6.44 [1.65, 25.21]5.73 [2.28, 14.42]8.44 [2.46, 29.01]8.45 [6.44, 11.10]SurgeryGlyc. Endp. |
Surgery_Schwartz_7911 | Surgery_Schwartz | [2.74, 14.88]11.48 [2.63, 50.13]10.83 [3 .79, 30.96]4.25 [1.92, 9.38]30.08 [10.28, 88.06]8.11 [2.37, 27.84]6.44 [1.65, 25.21]5.73 [2.28, 14.42]8.44 [2.46, 29.01]8.45 [6.44, 11.10]SurgeryGlyc. Endp. NMedical/LifestyleGlyc. Endp. NHeterogeneity: Chi2 = 45 .43, df = 14 (P < 0.0001); I2 = 69%Test for overall effect: Z = 15.36 (P < 0.00001)FavorsMedical/Lifestyle0.0010.11011000FavorsSurgeryIncreasing Length of Follow-UpFigure 27-27. Glycemic endpoints of RCTs by length of follow-up. Forest plot of Peto odds ratios (ORs) of main glycemic end points, as defined in each trial, from published RCTs of bariatric/metabolic surgery compared with medical/lifestyle treatments for diabetes with data arranged in order of increasing length of follow-up. (Reproduced with permission from Cummings DE, Cohen RV: Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2, Diabetes Care. 2016 Jun;39(6):924-933.)Brunicardi_Ch27_p1167-p1218.indd 120223/02/19 2:21 PM 1203THE | Surgery_Schwartz. [2.74, 14.88]11.48 [2.63, 50.13]10.83 [3 .79, 30.96]4.25 [1.92, 9.38]30.08 [10.28, 88.06]8.11 [2.37, 27.84]6.44 [1.65, 25.21]5.73 [2.28, 14.42]8.44 [2.46, 29.01]8.45 [6.44, 11.10]SurgeryGlyc. Endp. NMedical/LifestyleGlyc. Endp. NHeterogeneity: Chi2 = 45 .43, df = 14 (P < 0.0001); I2 = 69%Test for overall effect: Z = 15.36 (P < 0.00001)FavorsMedical/Lifestyle0.0010.11011000FavorsSurgeryIncreasing Length of Follow-UpFigure 27-27. Glycemic endpoints of RCTs by length of follow-up. Forest plot of Peto odds ratios (ORs) of main glycemic end points, as defined in each trial, from published RCTs of bariatric/metabolic surgery compared with medical/lifestyle treatments for diabetes with data arranged in order of increasing length of follow-up. (Reproduced with permission from Cummings DE, Cohen RV: Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2, Diabetes Care. 2016 Jun;39(6):924-933.)Brunicardi_Ch27_p1167-p1218.indd 120223/02/19 2:21 PM 1203THE |
Surgery_Schwartz_7912 | Surgery_Schwartz | RV: Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2, Diabetes Care. 2016 Jun;39(6):924-933.)Brunicardi_Ch27_p1167-p1218.indd 120223/02/19 2:21 PM 1203THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Patients WithType 2 DiabetesObeseBMI ˙30 kg/m2or ˙27.5 for AsiansNonobeseBMI <30 kg/m2or <27.5 for AsiansClass III ObeseBMI ˙40 kg/m2or ˙37.5 for AsiansClass II ObeseBMI 35.0–39.9 kg/m2or 32.5–37.4 for AsiansClass I ObeseBMI 30.0–34.9 kg/m2or 27.5–32.4 for AsiansClass II ObeseWith PoorGlycemic ControlRecommendMetabolic SurgeryConsiderMetabolic SurgeryNonsurgicalTreatmentClass II ObeseWith AdequateGlycemic ControlClass I ObeseWith PoorGlycemic ControlClass I ObeseWith AdequateGlycemic ControlExpedited Assessment for Metabolic SurgeryOptimal Lifestyle and Medical RxOptimal Lifestyle and Medical Rx (including injectable meds and insulin)Figure 27-29. Algorithm for the treatment of type 2 diabetes as recommended by the 2nd Diabetes Surgery Summit. | Surgery_Schwartz. RV: Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2, Diabetes Care. 2016 Jun;39(6):924-933.)Brunicardi_Ch27_p1167-p1218.indd 120223/02/19 2:21 PM 1203THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Patients WithType 2 DiabetesObeseBMI ˙30 kg/m2or ˙27.5 for AsiansNonobeseBMI <30 kg/m2or <27.5 for AsiansClass III ObeseBMI ˙40 kg/m2or ˙37.5 for AsiansClass II ObeseBMI 35.0–39.9 kg/m2or 32.5–37.4 for AsiansClass I ObeseBMI 30.0–34.9 kg/m2or 27.5–32.4 for AsiansClass II ObeseWith PoorGlycemic ControlRecommendMetabolic SurgeryConsiderMetabolic SurgeryNonsurgicalTreatmentClass II ObeseWith AdequateGlycemic ControlClass I ObeseWith PoorGlycemic ControlClass I ObeseWith AdequateGlycemic ControlExpedited Assessment for Metabolic SurgeryOptimal Lifestyle and Medical RxOptimal Lifestyle and Medical Rx (including injectable meds and insulin)Figure 27-29. Algorithm for the treatment of type 2 diabetes as recommended by the 2nd Diabetes Surgery Summit. |
Surgery_Schwartz_7913 | Surgery_Schwartz | and Medical RxOptimal Lifestyle and Medical Rx (including injectable meds and insulin)Figure 27-29. Algorithm for the treatment of type 2 diabetes as recommended by the 2nd Diabetes Surgery Summit. (Reproduced with permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations, Diabetes Care. 2016 Jun;39(6):861-877.)20–2–4–6Change in HbA1cMean baselineBMI 35 kg/m2Mean baselineBMI >35 kg/m2Wentworth 2014Liang 2013Parikh 2014Ikramuddin 2013Courcoulas 2014Courcoulas 2014Halperin 2014Ding 2015Dixon 2008Schauer 2012Schauer 2012Cummings 2016Mingrone 2012Mingrone 2012SurgeryMedical/LifestyleFigure 27-28. Change in baseline HbA1c in each of the 11 RCTs. (Reproduced with permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organiza-tions, Diabetes Care. 2016 | Surgery_Schwartz. and Medical RxOptimal Lifestyle and Medical Rx (including injectable meds and insulin)Figure 27-29. Algorithm for the treatment of type 2 diabetes as recommended by the 2nd Diabetes Surgery Summit. (Reproduced with permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations, Diabetes Care. 2016 Jun;39(6):861-877.)20–2–4–6Change in HbA1cMean baselineBMI 35 kg/m2Mean baselineBMI >35 kg/m2Wentworth 2014Liang 2013Parikh 2014Ikramuddin 2013Courcoulas 2014Courcoulas 2014Halperin 2014Ding 2015Dixon 2008Schauer 2012Schauer 2012Cummings 2016Mingrone 2012Mingrone 2012SurgeryMedical/LifestyleFigure 27-28. Change in baseline HbA1c in each of the 11 RCTs. (Reproduced with permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organiza-tions, Diabetes Care. 2016 |
Surgery_Schwartz_7914 | Surgery_Schwartz | permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organiza-tions, Diabetes Care. 2016 Jun;39(6):861-877.)guidelines that were endorsed by more than 50 diabetes and medical organizations.16 The recommendations include patient selection, preoperative evaluation, choice of procedure, postop-erative follow-up, and indications for surgery. According to the DSS-II guidelines, metabolic surgery should be recommended to treat T2DM in patients with class III obesity (BMI ≥40 kg/m2) regardless of glycemic control and in those with class II obesity (BMI 35.0–39.9 kg/m2) when hyperglycemia is inad-equately controlled by lifestyle and optimal medical therapy (Fig. 27-29). Surgery should also be considered for patients with T2DM and BMI 30.0 to 34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI | Surgery_Schwartz. permission from Rubino F, Nathan DM, Eckel RH, et al: Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organiza-tions, Diabetes Care. 2016 Jun;39(6):861-877.)guidelines that were endorsed by more than 50 diabetes and medical organizations.16 The recommendations include patient selection, preoperative evaluation, choice of procedure, postop-erative follow-up, and indications for surgery. According to the DSS-II guidelines, metabolic surgery should be recommended to treat T2DM in patients with class III obesity (BMI ≥40 kg/m2) regardless of glycemic control and in those with class II obesity (BMI 35.0–39.9 kg/m2) when hyperglycemia is inad-equately controlled by lifestyle and optimal medical therapy (Fig. 27-29). Surgery should also be considered for patients with T2DM and BMI 30.0 to 34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI |
Surgery_Schwartz_7915 | Surgery_Schwartz | should also be considered for patients with T2DM and BMI 30.0 to 34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. The new treatment algorithm from DSS-II incorporates appropriate use of all three treatment modalities: lifestyle intervention, drug therapy, and surgery (see Fig. 27-29).16 The 2017 Standards of Care for Dia-betes from the American Diabetes Association include those key indications in its recommendations for metabolic surgery, as well.COMPLICATIONS OF BARIATRIC SURGERYSurgical ComplicationsNone of the surgical procedures are without risks. The periop-erative mortality for the average patient is low (<0.5%) and declining, but can vary significantly across sub-groups with perioperative mortality rates of 2.0% or higher in some patient populations.1 The incidence of complications after the various surgical procedures varies from | Surgery_Schwartz. should also be considered for patients with T2DM and BMI 30.0 to 34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. The new treatment algorithm from DSS-II incorporates appropriate use of all three treatment modalities: lifestyle intervention, drug therapy, and surgery (see Fig. 27-29).16 The 2017 Standards of Care for Dia-betes from the American Diabetes Association include those key indications in its recommendations for metabolic surgery, as well.COMPLICATIONS OF BARIATRIC SURGERYSurgical ComplicationsNone of the surgical procedures are without risks. The periop-erative mortality for the average patient is low (<0.5%) and declining, but can vary significantly across sub-groups with perioperative mortality rates of 2.0% or higher in some patient populations.1 The incidence of complications after the various surgical procedures varies from |
Surgery_Schwartz_7916 | Surgery_Schwartz | significantly across sub-groups with perioperative mortality rates of 2.0% or higher in some patient populations.1 The incidence of complications after the various surgical procedures varies from 4% to over 25% and depends on the definition of complication used, the type of bariatric procedure performed, and patient characteristics216,254,255 (see Table 27-5).8Brunicardi_Ch27_p1167-p1218.indd 120323/02/19 2:21 PM 1204SPECIFIC CONSIDERATIONSPART IIIn the 11 RCTs (794 patients) that have compared bariatric surgery to nonsurgical treatment, rates of adverse events were higher among surgical subjects, with follow-up up to 5 years for two of the studies and up to 2 to 3 years for others.82,252,256 There were very few cardiovascular events or deaths in either the surgical or the nonsurgical groups, and the most common adverse events after surgery were iron deficiency anemia (15% with intestinal bypass operations) and reoperations (8%). These RCTs were not large enough to compare safety | Surgery_Schwartz. significantly across sub-groups with perioperative mortality rates of 2.0% or higher in some patient populations.1 The incidence of complications after the various surgical procedures varies from 4% to over 25% and depends on the definition of complication used, the type of bariatric procedure performed, and patient characteristics216,254,255 (see Table 27-5).8Brunicardi_Ch27_p1167-p1218.indd 120323/02/19 2:21 PM 1204SPECIFIC CONSIDERATIONSPART IIIn the 11 RCTs (794 patients) that have compared bariatric surgery to nonsurgical treatment, rates of adverse events were higher among surgical subjects, with follow-up up to 5 years for two of the studies and up to 2 to 3 years for others.82,252,256 There were very few cardiovascular events or deaths in either the surgical or the nonsurgical groups, and the most common adverse events after surgery were iron deficiency anemia (15% with intestinal bypass operations) and reoperations (8%). These RCTs were not large enough to compare safety |
Surgery_Schwartz_7917 | Surgery_Schwartz | groups, and the most common adverse events after surgery were iron deficiency anemia (15% with intestinal bypass operations) and reoperations (8%). These RCTs were not large enough to compare safety between pro-cedure types, and most of the comparative data on procedure-to-procedure complications has and will come from larger observational studies.The 30-day mortality in the LABS Study was 0.3% for all procedures with a major adverse outcome rate (a predefined composite endpoint that included; death, venous thromboembo-lism, reintervention [percutaneous, endoscopic, or operative], or failure to be discharged from the hospital in 30 days) of 4.1%.59 Major predictors of an increased risk of complications in LABS were a history of venous thromboembolism, a diagnosis of obstructive sleep apnea, impaired functional status defined as inability to walk 300 feet (91 m), extreme BMI, and undergo-ing an RYGB by the open technique. Other large observational studies, such as SOS, have shown | Surgery_Schwartz. groups, and the most common adverse events after surgery were iron deficiency anemia (15% with intestinal bypass operations) and reoperations (8%). These RCTs were not large enough to compare safety between pro-cedure types, and most of the comparative data on procedure-to-procedure complications has and will come from larger observational studies.The 30-day mortality in the LABS Study was 0.3% for all procedures with a major adverse outcome rate (a predefined composite endpoint that included; death, venous thromboembo-lism, reintervention [percutaneous, endoscopic, or operative], or failure to be discharged from the hospital in 30 days) of 4.1%.59 Major predictors of an increased risk of complications in LABS were a history of venous thromboembolism, a diagnosis of obstructive sleep apnea, impaired functional status defined as inability to walk 300 feet (91 m), extreme BMI, and undergo-ing an RYGB by the open technique. Other large observational studies, such as SOS, have shown |
Surgery_Schwartz_7918 | Surgery_Schwartz | apnea, impaired functional status defined as inability to walk 300 feet (91 m), extreme BMI, and undergo-ing an RYGB by the open technique. Other large observational studies, such as SOS, have shown higher rates of complications, with 14.5% having at least one nonfatal complication over the first 90 days, including pulmonary complications, vomiting, wound infection, hemorrhage, and anastomotic leak. However, the SOS included mostly open and VBG procedures, which are rarely performed today. Despite these older procedures and tech-niques, the 90-day mortality rate in SOS was low at 0.25%.196In a 2007 meta-analysis of 361 studies, mostly nonran-domized observational studies involving over 85,000 patients, Buchwald and colleagues reported important differences in ≤30-day mortality across different laparoscopic bariatric pro-cedures: 0.06% for LAGB; 0.21% for VBG; 0.16% for RYGB; and 1.11% for BPD/DS.257 This review also found significantly higher mortality for open procedures compared | Surgery_Schwartz. apnea, impaired functional status defined as inability to walk 300 feet (91 m), extreme BMI, and undergo-ing an RYGB by the open technique. Other large observational studies, such as SOS, have shown higher rates of complications, with 14.5% having at least one nonfatal complication over the first 90 days, including pulmonary complications, vomiting, wound infection, hemorrhage, and anastomotic leak. However, the SOS included mostly open and VBG procedures, which are rarely performed today. Despite these older procedures and tech-niques, the 90-day mortality rate in SOS was low at 0.25%.196In a 2007 meta-analysis of 361 studies, mostly nonran-domized observational studies involving over 85,000 patients, Buchwald and colleagues reported important differences in ≤30-day mortality across different laparoscopic bariatric pro-cedures: 0.06% for LAGB; 0.21% for VBG; 0.16% for RYGB; and 1.11% for BPD/DS.257 This review also found significantly higher mortality for open procedures compared |
Surgery_Schwartz_7919 | Surgery_Schwartz | laparoscopic bariatric pro-cedures: 0.06% for LAGB; 0.21% for VBG; 0.16% for RYGB; and 1.11% for BPD/DS.257 This review also found significantly higher mortality for open procedures compared with those per-formed laparoscopically. A U.S. study of over 300,000 patients in 12 states examined in-hospital complications before and after implementation of the CMS national policy restricting insurance coverage for bariatric surgery to “centers of excellence.” The study found no significant differences in complications before and after the policy was implemented, and overall complication rates were 7% to 8% with 3.3% to 3.6% being serious, including a 1% reoperation rate during both time periods.1,258 A clinically useful prognostic risk score was also developed and validated in 9382 patients to predict 90-day mortality after LRYGB surgery using five clinical characteristics: BMI ≥50 kg/m2, male sex, hypertension, known risk factor for pulmonary embolism, and age ≥45 years. Patients with 4 to | Surgery_Schwartz. laparoscopic bariatric pro-cedures: 0.06% for LAGB; 0.21% for VBG; 0.16% for RYGB; and 1.11% for BPD/DS.257 This review also found significantly higher mortality for open procedures compared with those per-formed laparoscopically. A U.S. study of over 300,000 patients in 12 states examined in-hospital complications before and after implementation of the CMS national policy restricting insurance coverage for bariatric surgery to “centers of excellence.” The study found no significant differences in complications before and after the policy was implemented, and overall complication rates were 7% to 8% with 3.3% to 3.6% being serious, including a 1% reoperation rate during both time periods.1,258 A clinically useful prognostic risk score was also developed and validated in 9382 patients to predict 90-day mortality after LRYGB surgery using five clinical characteristics: BMI ≥50 kg/m2, male sex, hypertension, known risk factor for pulmonary embolism, and age ≥45 years. Patients with 4 to |
Surgery_Schwartz_7920 | Surgery_Schwartz | 90-day mortality after LRYGB surgery using five clinical characteristics: BMI ≥50 kg/m2, male sex, hypertension, known risk factor for pulmonary embolism, and age ≥45 years. Patients with 4 to 5 of these characteristics are at much higher risk of death (4.3%) by 90 days than those with 0 to 1 characteristics (0.26%).259-261 A systematic review of 15 RCTs of SG found no deaths in just under 800 patients but a 9.2% mean complication rate (range 0–18%).224 In the American College of Surgeons Bariatric Surgery Network database, mor-tality 30 days after SG was 0.11%, positioning its overall com-plication profile between that for LAGB (0.05%) and RYGB (0.14%). The 30-day complication rate was similarly positioned at 5.6% for SG, 1.4% LAGB, and 5.9% for RYGB.140An established problem now is the frequent rate of reop-eration, particularly among LAGB patients. In O’Brien and col-leagues’ prospective cohort of 3227 LAGB patients, revisional procedures occurred in 1116 (35%) and were performed | Surgery_Schwartz. 90-day mortality after LRYGB surgery using five clinical characteristics: BMI ≥50 kg/m2, male sex, hypertension, known risk factor for pulmonary embolism, and age ≥45 years. Patients with 4 to 5 of these characteristics are at much higher risk of death (4.3%) by 90 days than those with 0 to 1 characteristics (0.26%).259-261 A systematic review of 15 RCTs of SG found no deaths in just under 800 patients but a 9.2% mean complication rate (range 0–18%).224 In the American College of Surgeons Bariatric Surgery Network database, mor-tality 30 days after SG was 0.11%, positioning its overall com-plication profile between that for LAGB (0.05%) and RYGB (0.14%). The 30-day complication rate was similarly positioned at 5.6% for SG, 1.4% LAGB, and 5.9% for RYGB.140An established problem now is the frequent rate of reop-eration, particularly among LAGB patients. In O’Brien and col-leagues’ prospective cohort of 3227 LAGB patients, revisional procedures occurred in 1116 (35%) and were performed |
Surgery_Schwartz_7921 | Surgery_Schwartz | frequent rate of reop-eration, particularly among LAGB patients. In O’Brien and col-leagues’ prospective cohort of 3227 LAGB patients, revisional procedures occurred in 1116 (35%) and were performed for the following reasons: proximal enlargement (26%), port and tubing problems (21%), and erosion (3.4%). The need for revision due to proximal enlargement decreased dramatically over a 17-year period from 40% to 6.4% as the surgical technique evolved; however, the band was ultimately removed in 5.6% of all indi-viduals.262 Other long-term cohorts suggest that LAGB removal rates may be as high as 50%. The O’Brien systematic review of long-term studies indicates that the rate of revisional surgery for LRYGB may be similar to LAGB (22% revision for LRYGB, range 8% to 38%; 26% revision for LAGB, range of 8% to 60%). However, in the LABS Study, there was a higher rate of revision and reoperation for LAGB as compared to RYGB at both 3 and 7 years of follow-up.169 In general, more long-term | Surgery_Schwartz. frequent rate of reop-eration, particularly among LAGB patients. In O’Brien and col-leagues’ prospective cohort of 3227 LAGB patients, revisional procedures occurred in 1116 (35%) and were performed for the following reasons: proximal enlargement (26%), port and tubing problems (21%), and erosion (3.4%). The need for revision due to proximal enlargement decreased dramatically over a 17-year period from 40% to 6.4% as the surgical technique evolved; however, the band was ultimately removed in 5.6% of all indi-viduals.262 Other long-term cohorts suggest that LAGB removal rates may be as high as 50%. The O’Brien systematic review of long-term studies indicates that the rate of revisional surgery for LRYGB may be similar to LAGB (22% revision for LRYGB, range 8% to 38%; 26% revision for LAGB, range of 8% to 60%). However, in the LABS Study, there was a higher rate of revision and reoperation for LAGB as compared to RYGB at both 3 and 7 years of follow-up.169 In general, more long-term |
Surgery_Schwartz_7922 | Surgery_Schwartz | range of 8% to 60%). However, in the LABS Study, there was a higher rate of revision and reoperation for LAGB as compared to RYGB at both 3 and 7 years of follow-up.169 In general, more long-term data with more complete follow-up with standardized defini-tions and reporting of complications are needed to compare reoperation and complication rates of all bariatric procedures.Nonsurgical ComplicationsPostgastric bypass hypoglycemia (PGBH) in a relatively uncommon but particularly challenging problem that affects an unknown number of patients in the longer term. Prevalence rates in the literature vary from 1% to 11%, depending on the defini-tion.263,264 Hypoglycemia is characterized by documentation of Whipple’s triad (including both autonomic and neuroglycopenic symptoms or signs), at the time of a plasma glucose concentration <55 mg/dL with resolution of symptoms and signs after glucose administration. During these episodes, plasma insulin levels are inappropriately high, indicating | Surgery_Schwartz. range of 8% to 60%). However, in the LABS Study, there was a higher rate of revision and reoperation for LAGB as compared to RYGB at both 3 and 7 years of follow-up.169 In general, more long-term data with more complete follow-up with standardized defini-tions and reporting of complications are needed to compare reoperation and complication rates of all bariatric procedures.Nonsurgical ComplicationsPostgastric bypass hypoglycemia (PGBH) in a relatively uncommon but particularly challenging problem that affects an unknown number of patients in the longer term. Prevalence rates in the literature vary from 1% to 11%, depending on the defini-tion.263,264 Hypoglycemia is characterized by documentation of Whipple’s triad (including both autonomic and neuroglycopenic symptoms or signs), at the time of a plasma glucose concentration <55 mg/dL with resolution of symptoms and signs after glucose administration. During these episodes, plasma insulin levels are inappropriately high, indicating |
Surgery_Schwartz_7923 | Surgery_Schwartz | time of a plasma glucose concentration <55 mg/dL with resolution of symptoms and signs after glucose administration. During these episodes, plasma insulin levels are inappropriately high, indicating dysregulation of β-cell function. When it was initially described in patients who had undergone partial pancreatectomy, nesidioblastosis was found in the speci-mens that are characterized by hyperplasia and/or dysplasia of the pancreatic islets.265 It was initially thought to be endogenous hyperinsulinemia from increased β-cell mass hyperfunctioning islet cells; however, the current thinking is that the recalcitrant symptoms of hyperinsulinemic hypoglycemia after RYGB are related to the anatomic and physiologic changes and not from an inherent change in β-cell mass. One candidate mediator of increased insulin secretion in PGBH is GLP-1, a peptide released from intestinal neuroendocrine L-cells in response to meals. Consistent with this hypothesis, postprandial GLP-1 levels are increased | Surgery_Schwartz. time of a plasma glucose concentration <55 mg/dL with resolution of symptoms and signs after glucose administration. During these episodes, plasma insulin levels are inappropriately high, indicating dysregulation of β-cell function. When it was initially described in patients who had undergone partial pancreatectomy, nesidioblastosis was found in the speci-mens that are characterized by hyperplasia and/or dysplasia of the pancreatic islets.265 It was initially thought to be endogenous hyperinsulinemia from increased β-cell mass hyperfunctioning islet cells; however, the current thinking is that the recalcitrant symptoms of hyperinsulinemic hypoglycemia after RYGB are related to the anatomic and physiologic changes and not from an inherent change in β-cell mass. One candidate mediator of increased insulin secretion in PGBH is GLP-1, a peptide released from intestinal neuroendocrine L-cells in response to meals. Consistent with this hypothesis, postprandial GLP-1 levels are increased |
Surgery_Schwartz_7924 | Surgery_Schwartz | increased insulin secretion in PGBH is GLP-1, a peptide released from intestinal neuroendocrine L-cells in response to meals. Consistent with this hypothesis, postprandial GLP-1 levels are increased by over tenfold in post-RYGB patients, are higher in those with hyperinsulinemic hypoglycemia and neuroglyco-penia, and correlate inversely with postprandial glucose lev-els.266 PGBH needs to be distinguished from other forms of hypoglycemia such as other functional β-cell disorders such as noninsulinoma pancreatogenous hypoglycemia, insulinoma, reactive hypoglycemia, or early or late dumping syndrome. It is possible that PGBH is a spectrum of hypoglycemia with late dumping being on the end of the spectrum that is more respon-sive to dietary changes alone while more severe PGBH can be associated with severe symptoms.263 First-line therapeutic approaches to PGBH include medical nutrition therapy aimed at reducing intake of high glycemic index carbohydrates and premeal treatment with | Surgery_Schwartz. increased insulin secretion in PGBH is GLP-1, a peptide released from intestinal neuroendocrine L-cells in response to meals. Consistent with this hypothesis, postprandial GLP-1 levels are increased by over tenfold in post-RYGB patients, are higher in those with hyperinsulinemic hypoglycemia and neuroglyco-penia, and correlate inversely with postprandial glucose lev-els.266 PGBH needs to be distinguished from other forms of hypoglycemia such as other functional β-cell disorders such as noninsulinoma pancreatogenous hypoglycemia, insulinoma, reactive hypoglycemia, or early or late dumping syndrome. It is possible that PGBH is a spectrum of hypoglycemia with late dumping being on the end of the spectrum that is more respon-sive to dietary changes alone while more severe PGBH can be associated with severe symptoms.263 First-line therapeutic approaches to PGBH include medical nutrition therapy aimed at reducing intake of high glycemic index carbohydrates and premeal treatment with |
Surgery_Schwartz_7925 | Surgery_Schwartz | with severe symptoms.263 First-line therapeutic approaches to PGBH include medical nutrition therapy aimed at reducing intake of high glycemic index carbohydrates and premeal treatment with acarbose. Additional therapies that may be considered include octreotide, diazoxide, calcium channel blockers, GLP-1 receptor antagonists, and providing nutrition solely through a gastrostomy tube placed into the bypassed duo-denum. Reversal of gastric bypass is not uniformly successful, suggesting the importance of underlying genetics and/or com-pensatory mechanisms that may persist after surgical reversal.266 Finally, although pancreatic resection was initially employed for patients with life-threatening hypoglycemia, this procedure Brunicardi_Ch27_p1167-p1218.indd 120423/02/19 2:21 PM 1205THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27is not uniformly successful in remitting hypoglycemia and should not be considered for the majority of patients, who can experience improvement in their symptoms | Surgery_Schwartz. with severe symptoms.263 First-line therapeutic approaches to PGBH include medical nutrition therapy aimed at reducing intake of high glycemic index carbohydrates and premeal treatment with acarbose. Additional therapies that may be considered include octreotide, diazoxide, calcium channel blockers, GLP-1 receptor antagonists, and providing nutrition solely through a gastrostomy tube placed into the bypassed duo-denum. Reversal of gastric bypass is not uniformly successful, suggesting the importance of underlying genetics and/or com-pensatory mechanisms that may persist after surgical reversal.266 Finally, although pancreatic resection was initially employed for patients with life-threatening hypoglycemia, this procedure Brunicardi_Ch27_p1167-p1218.indd 120423/02/19 2:21 PM 1205THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27is not uniformly successful in remitting hypoglycemia and should not be considered for the majority of patients, who can experience improvement in their symptoms |
Surgery_Schwartz_7926 | Surgery_Schwartz | MANAGEMENT OF OBESITYCHAPTER 27is not uniformly successful in remitting hypoglycemia and should not be considered for the majority of patients, who can experience improvement in their symptoms with a combination of medical approaches. A 2017 American Society of Metabolic and Bariatric Surgery (ASMBS) position statement provides a comprehensive summary of this topic and also recommends this multimodal medical approach.267There is data to suggest that babies born to women follow-ing bariatric surgery are at risk for certain complications. In a Swedish study, bariatric surgery was originally associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, and an increased risk of small-for-gestational-age infants. In a later follow-up report, this same group reported a significant association between a history of bariatric surgery and an increased risk of preterm birth and spontaneous preterm birth, in particular.119,268There is also emerging data from | Surgery_Schwartz. MANAGEMENT OF OBESITYCHAPTER 27is not uniformly successful in remitting hypoglycemia and should not be considered for the majority of patients, who can experience improvement in their symptoms with a combination of medical approaches. A 2017 American Society of Metabolic and Bariatric Surgery (ASMBS) position statement provides a comprehensive summary of this topic and also recommends this multimodal medical approach.267There is data to suggest that babies born to women follow-ing bariatric surgery are at risk for certain complications. In a Swedish study, bariatric surgery was originally associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, and an increased risk of small-for-gestational-age infants. In a later follow-up report, this same group reported a significant association between a history of bariatric surgery and an increased risk of preterm birth and spontaneous preterm birth, in particular.119,268There is also emerging data from |
Surgery_Schwartz_7927 | Surgery_Schwartz | reported a significant association between a history of bariatric surgery and an increased risk of preterm birth and spontaneous preterm birth, in particular.119,268There is also emerging data from observational studies that some bariatric procedures may be associated with a greater long-term risk of substance and alcohol use disorders, suicide, and nutritional deficiencies. Pharmacokinetic studies indicate that after LRYGB and SG, the anatomic changes lead to very rapid absorption of alcohol and marked increases in blood alco-hol concentrations for a single small.269,270 In the SOS study, RYGB was associated with increased alcohol consumption and an increase in alcohol abuse events (HR: 4.9) over 20 years.196 Similarly in the LABS study, alcohol use disorders were found to be more common in the second postoperative year (9.6%) in those undergoing RYGB compared to before surgery (7.6%). Risk factors for alcohol use disorders included male gender, younger age, and preoperative smoking | Surgery_Schwartz. reported a significant association between a history of bariatric surgery and an increased risk of preterm birth and spontaneous preterm birth, in particular.119,268There is also emerging data from observational studies that some bariatric procedures may be associated with a greater long-term risk of substance and alcohol use disorders, suicide, and nutritional deficiencies. Pharmacokinetic studies indicate that after LRYGB and SG, the anatomic changes lead to very rapid absorption of alcohol and marked increases in blood alco-hol concentrations for a single small.269,270 In the SOS study, RYGB was associated with increased alcohol consumption and an increase in alcohol abuse events (HR: 4.9) over 20 years.196 Similarly in the LABS study, alcohol use disorders were found to be more common in the second postoperative year (9.6%) in those undergoing RYGB compared to before surgery (7.6%). Risk factors for alcohol use disorders included male gender, younger age, and preoperative smoking |
Surgery_Schwartz_7928 | Surgery_Schwartz | in the second postoperative year (9.6%) in those undergoing RYGB compared to before surgery (7.6%). Risk factors for alcohol use disorders included male gender, younger age, and preoperative smoking or alcohol use.271 At 7-year follow-up in LABS, there was a progressive and sig-nificant increase over time in the prevalence of regular alcohol consumption for both RYGB and LAGB. In addition, alcohol use disorders, illicit drug use, and treatment for substance use disorders, increased over the 7-year period for RYGB only.272 Overall, these rates were high, with 20% of RYGB participants reporting incident alcohol use disorder symptoms within 5 years of surgery.In addition, there may be an increased risk for suicide273-275 following bariatric surgery, although the etiology is unclear and the data is varied and complex to interpret.276 The Utah mortality study showed a 58% increase in all non–disease-related causes of death in the RYGB group compared to the matched control population, | Surgery_Schwartz. in the second postoperative year (9.6%) in those undergoing RYGB compared to before surgery (7.6%). Risk factors for alcohol use disorders included male gender, younger age, and preoperative smoking or alcohol use.271 At 7-year follow-up in LABS, there was a progressive and sig-nificant increase over time in the prevalence of regular alcohol consumption for both RYGB and LAGB. In addition, alcohol use disorders, illicit drug use, and treatment for substance use disorders, increased over the 7-year period for RYGB only.272 Overall, these rates were high, with 20% of RYGB participants reporting incident alcohol use disorder symptoms within 5 years of surgery.In addition, there may be an increased risk for suicide273-275 following bariatric surgery, although the etiology is unclear and the data is varied and complex to interpret.276 The Utah mortality study showed a 58% increase in all non–disease-related causes of death in the RYGB group compared to the matched control population, |
Surgery_Schwartz_7929 | Surgery_Schwartz | the data is varied and complex to interpret.276 The Utah mortality study showed a 58% increase in all non–disease-related causes of death in the RYGB group compared to the matched control population, including a small but significant increase in suicides, accidents, and intentional poisonings.202 Similar findings were observed in the second Utah Obesity Study.203 An observational study using Pennsylvania state data found that suicide rates were 13.7 per 10,000 among men and 5.2 per 10,000 among women among postbariatric surgery patients in Pennsylvania over 10 years, which were both significantly higher than age and sex-matched rates in the United States. In addition, the majority (70%) of these deaths occurred in the first 3 years following surgery when clinical follow-up is incomplete.277Finally, there is evidence that vitamin and micronutrient deficiencies are common following bariatric surgery including calcium, vitamin D, iron, zinc, and copper, and others. Guide-lines suggest | Surgery_Schwartz. the data is varied and complex to interpret.276 The Utah mortality study showed a 58% increase in all non–disease-related causes of death in the RYGB group compared to the matched control population, including a small but significant increase in suicides, accidents, and intentional poisonings.202 Similar findings were observed in the second Utah Obesity Study.203 An observational study using Pennsylvania state data found that suicide rates were 13.7 per 10,000 among men and 5.2 per 10,000 among women among postbariatric surgery patients in Pennsylvania over 10 years, which were both significantly higher than age and sex-matched rates in the United States. In addition, the majority (70%) of these deaths occurred in the first 3 years following surgery when clinical follow-up is incomplete.277Finally, there is evidence that vitamin and micronutrient deficiencies are common following bariatric surgery including calcium, vitamin D, iron, zinc, and copper, and others. Guide-lines suggest |
Surgery_Schwartz_7930 | Surgery_Schwartz | there is evidence that vitamin and micronutrient deficiencies are common following bariatric surgery including calcium, vitamin D, iron, zinc, and copper, and others. Guide-lines suggest that all patients should be screened for deficiencies preoperatively as some deficiencies predate the surgical pro-cedure (see “Follow-Up Postoperative Care”). After surgery, patients must be provided daily nutritional supplementation and undergo routine long-term monitoring for deficiencies (see Table 27-4). Data continue to suggest that the prevalence of micronutrient deficiencies is increasing, while monitoring is decreasing. Aside from these recommendations, there is insuf-ficient evidence currently regarding optimal dietary and nutri-tional management following bariatric procedures, including how to treat some of the specific complications of bariatric operations such as chronic nausea and vomiting, hypoglyce-mic episodes, failed weight loss, and anastomotic ulcers and | Surgery_Schwartz. there is evidence that vitamin and micronutrient deficiencies are common following bariatric surgery including calcium, vitamin D, iron, zinc, and copper, and others. Guide-lines suggest that all patients should be screened for deficiencies preoperatively as some deficiencies predate the surgical pro-cedure (see “Follow-Up Postoperative Care”). After surgery, patients must be provided daily nutritional supplementation and undergo routine long-term monitoring for deficiencies (see Table 27-4). Data continue to suggest that the prevalence of micronutrient deficiencies is increasing, while monitoring is decreasing. Aside from these recommendations, there is insuf-ficient evidence currently regarding optimal dietary and nutri-tional management following bariatric procedures, including how to treat some of the specific complications of bariatric operations such as chronic nausea and vomiting, hypoglyce-mic episodes, failed weight loss, and anastomotic ulcers and |
Surgery_Schwartz_7931 | Surgery_Schwartz | including how to treat some of the specific complications of bariatric operations such as chronic nausea and vomiting, hypoglyce-mic episodes, failed weight loss, and anastomotic ulcers and strictures.1,278-280REOPERATIVE (REVISION AND CONVERSION) BARIATRIC SURGERYIntroductionSurgical treatments for chronic diseases such as obesity often require additional or revisional surgical procedures when the primary procedure did not sufficiently treat the underly-ing disease. This is true in joint replacements when treating osteo-arthritis, coronary-artery bypass graft surgeries when treating coronary artery disease, and bariatric surgery in the treatment of obesity.281 Additionally, we suspect that obesity is a heteroge-neous disorder282 and is therefore being treated with a variety of procedures with different mechanisms of action.63 Given this, it is not surprising that some patients are “treatment failures” with respect to improvements in weight, comorbidities, and quality of life. Also, | Surgery_Schwartz. including how to treat some of the specific complications of bariatric operations such as chronic nausea and vomiting, hypoglyce-mic episodes, failed weight loss, and anastomotic ulcers and strictures.1,278-280REOPERATIVE (REVISION AND CONVERSION) BARIATRIC SURGERYIntroductionSurgical treatments for chronic diseases such as obesity often require additional or revisional surgical procedures when the primary procedure did not sufficiently treat the underly-ing disease. This is true in joint replacements when treating osteo-arthritis, coronary-artery bypass graft surgeries when treating coronary artery disease, and bariatric surgery in the treatment of obesity.281 Additionally, we suspect that obesity is a heteroge-neous disorder282 and is therefore being treated with a variety of procedures with different mechanisms of action.63 Given this, it is not surprising that some patients are “treatment failures” with respect to improvements in weight, comorbidities, and quality of life. Also, |
Surgery_Schwartz_7932 | Surgery_Schwartz | with different mechanisms of action.63 Given this, it is not surprising that some patients are “treatment failures” with respect to improvements in weight, comorbidities, and quality of life. Also, older bariatric surgical procedures such as the jejunal-ileal bypass, the VBG, and early gastric bypass procedures (which utilized a horizontal and/or partitioned stomach) require revision because of a higher complication rate.283,284 Initial bariatric sur-gery cases have averaged greater than 150,000 cases per year for the last 15 years.285 For these reasons, reoperative bariatric sur-gery has become increasingly prevalent over the last decade. Despite its increasing prevalence, there are challenges in assess-ing the frequency and effectiveness of these procedures. Reopera-tive bariatric surgery has been difficult to categorize meaningfully and to quantify due to the multiple procedure codes, many with little specificity. Reports in the literature range from 5% to 50% depending on the | Surgery_Schwartz. with different mechanisms of action.63 Given this, it is not surprising that some patients are “treatment failures” with respect to improvements in weight, comorbidities, and quality of life. Also, older bariatric surgical procedures such as the jejunal-ileal bypass, the VBG, and early gastric bypass procedures (which utilized a horizontal and/or partitioned stomach) require revision because of a higher complication rate.283,284 Initial bariatric sur-gery cases have averaged greater than 150,000 cases per year for the last 15 years.285 For these reasons, reoperative bariatric sur-gery has become increasingly prevalent over the last decade. Despite its increasing prevalence, there are challenges in assess-ing the frequency and effectiveness of these procedures. Reopera-tive bariatric surgery has been difficult to categorize meaningfully and to quantify due to the multiple procedure codes, many with little specificity. Reports in the literature range from 5% to 50% depending on the |
Surgery_Schwartz_7933 | Surgery_Schwartz | has been difficult to categorize meaningfully and to quantify due to the multiple procedure codes, many with little specificity. Reports in the literature range from 5% to 50% depending on the primary procedure.283Multiple retrospective, as well as case-matched and case-controlled studies of revisional bariatric surgery, demonstrate they are effective with benefits to weight loss and overall health,281,283 although this is not without some controversy. The literature supports reoperative bariatric surgery in two situa-tions: treatments of insufficient weight loss or weight regain and the treatment of acute and chronic complications.281,285 There are many revisional procedures and approaches that are effective. There is no data-driven evidence to guide in the selection of which patient will benefit most from revisional bariatric surgery. Additionally, there is no evidence-based consensus as to which revisional surgical approach is most optimal in any given situa-tion.283 Currently, | Surgery_Schwartz. has been difficult to categorize meaningfully and to quantify due to the multiple procedure codes, many with little specificity. Reports in the literature range from 5% to 50% depending on the primary procedure.283Multiple retrospective, as well as case-matched and case-controlled studies of revisional bariatric surgery, demonstrate they are effective with benefits to weight loss and overall health,281,283 although this is not without some controversy. The literature supports reoperative bariatric surgery in two situa-tions: treatments of insufficient weight loss or weight regain and the treatment of acute and chronic complications.281,285 There are many revisional procedures and approaches that are effective. There is no data-driven evidence to guide in the selection of which patient will benefit most from revisional bariatric surgery. Additionally, there is no evidence-based consensus as to which revisional surgical approach is most optimal in any given situa-tion.283 Currently, |
Surgery_Schwartz_7934 | Surgery_Schwartz | benefit most from revisional bariatric surgery. Additionally, there is no evidence-based consensus as to which revisional surgical approach is most optimal in any given situa-tion.283 Currently, there is also little evidence as to which bariat-ric surgical procedure will be efficacious for any specific given patient.286,287Principles and Preoperative EvaluationAs with any other decisions for surgery, revisional or addi-tional bariatric surgery requires evaluating the risks and the benefits of the procedure for specific patient situations. It has been observed that the weight loss following revisional pro-cedures is less than with a primary procedure.288 Reoperations in general are associated with morbidity and mortality that is higher than with primary bariatric procedures281,288,289 but are acceptably low if careful selection of patients is coupled with 9Brunicardi_Ch27_p1167-p1218.indd 120523/02/19 2:21 PM 1206SPECIFIC CONSIDERATIONSPART IIadequate surgeon experience.281,290 | Surgery_Schwartz. benefit most from revisional bariatric surgery. Additionally, there is no evidence-based consensus as to which revisional surgical approach is most optimal in any given situa-tion.283 Currently, there is also little evidence as to which bariat-ric surgical procedure will be efficacious for any specific given patient.286,287Principles and Preoperative EvaluationAs with any other decisions for surgery, revisional or addi-tional bariatric surgery requires evaluating the risks and the benefits of the procedure for specific patient situations. It has been observed that the weight loss following revisional pro-cedures is less than with a primary procedure.288 Reoperations in general are associated with morbidity and mortality that is higher than with primary bariatric procedures281,288,289 but are acceptably low if careful selection of patients is coupled with 9Brunicardi_Ch27_p1167-p1218.indd 120523/02/19 2:21 PM 1206SPECIFIC CONSIDERATIONSPART IIadequate surgeon experience.281,290 |
Surgery_Schwartz_7935 | Surgery_Schwartz | are acceptably low if careful selection of patients is coupled with 9Brunicardi_Ch27_p1167-p1218.indd 120523/02/19 2:21 PM 1206SPECIFIC CONSIDERATIONSPART IIadequate surgeon experience.281,290 Reoperative bariatric surgery should be undertaken by experienced bariatric surgeons in cen-ters with the wide range of medical resources to manage these complex patients.281 In some situations, it is reasonable to con-sider a two-stage or an open vs. laparoscopic approach.285 When evaluating a patient for revisional bariatric surgery, it is most important to establish clearly the reason for revision.283,291 Is the issue a surgical complication, insufficient weight loss, or weight regain? Is there a discernable anatomic cause for the patient’s symptoms (e.g., abdominal pain, nausea, vomiting, heartburn or reflux, nutritional deficiency)? In situations of noninitial weight loss or weight regain, what is the best justification that can be made? Are there behavioral, or other nonsurgical | Surgery_Schwartz. are acceptably low if careful selection of patients is coupled with 9Brunicardi_Ch27_p1167-p1218.indd 120523/02/19 2:21 PM 1206SPECIFIC CONSIDERATIONSPART IIadequate surgeon experience.281,290 Reoperative bariatric surgery should be undertaken by experienced bariatric surgeons in cen-ters with the wide range of medical resources to manage these complex patients.281 In some situations, it is reasonable to con-sider a two-stage or an open vs. laparoscopic approach.285 When evaluating a patient for revisional bariatric surgery, it is most important to establish clearly the reason for revision.283,291 Is the issue a surgical complication, insufficient weight loss, or weight regain? Is there a discernable anatomic cause for the patient’s symptoms (e.g., abdominal pain, nausea, vomiting, heartburn or reflux, nutritional deficiency)? In situations of noninitial weight loss or weight regain, what is the best justification that can be made? Are there behavioral, or other nonsurgical |
Surgery_Schwartz_7936 | Surgery_Schwartz | heartburn or reflux, nutritional deficiency)? In situations of noninitial weight loss or weight regain, what is the best justification that can be made? Are there behavioral, or other nonsurgical modifications that might significantly help to attain further weight loss? Will the patient be able to set into place the behavioral modification required of the revisional surgical approach? With consideration for revision, it is reasonable to place less emphasis on absolute weight loss and focus on the comorbidity and quality of life states. A comprehensive preoperative evaluation is required to fully answer these and other questions.The preoperative evaluation for bariatric surgical revision should include• Review of the initial surgical operative note to understand the exact initial procedure• Anatomic evaluation of the GI track utilizing upper gastroin-testinal endoscopy and radiology to identify known bariatric surgical complications• An extensive nutritional evaluation• A behavioral | Surgery_Schwartz. heartburn or reflux, nutritional deficiency)? In situations of noninitial weight loss or weight regain, what is the best justification that can be made? Are there behavioral, or other nonsurgical modifications that might significantly help to attain further weight loss? Will the patient be able to set into place the behavioral modification required of the revisional surgical approach? With consideration for revision, it is reasonable to place less emphasis on absolute weight loss and focus on the comorbidity and quality of life states. A comprehensive preoperative evaluation is required to fully answer these and other questions.The preoperative evaluation for bariatric surgical revision should include• Review of the initial surgical operative note to understand the exact initial procedure• Anatomic evaluation of the GI track utilizing upper gastroin-testinal endoscopy and radiology to identify known bariatric surgical complications• An extensive nutritional evaluation• A behavioral |
Surgery_Schwartz_7937 | Surgery_Schwartz | evaluation of the GI track utilizing upper gastroin-testinal endoscopy and radiology to identify known bariatric surgical complications• An extensive nutritional evaluation• A behavioral health evaluation with a focus on the adaption to the initial bariatric procedure and potential adaptation to a revisional procedure• A full medical evaluation to determine the patient’s suitability to undergo anesthesia and a surgical procedure288,291The results from these evaluations are used to formulate a hypothesis to explain the patient’s symptoms and outcome from the initial procedure and to assess their suitability for and the potential benefits from the potential revisional surgical options. It will come down to a risk-benefit discussion between the sur-geon, other members of the multidisciplinary support team, and the patient.281Treatment for Insufficient Weight Loss or Weight RegainVertical Banded Gastroplasty. Reversal of VBG is associ-ated with significant weight gain. Revision of the VBG | Surgery_Schwartz. evaluation of the GI track utilizing upper gastroin-testinal endoscopy and radiology to identify known bariatric surgical complications• An extensive nutritional evaluation• A behavioral health evaluation with a focus on the adaption to the initial bariatric procedure and potential adaptation to a revisional procedure• A full medical evaluation to determine the patient’s suitability to undergo anesthesia and a surgical procedure288,291The results from these evaluations are used to formulate a hypothesis to explain the patient’s symptoms and outcome from the initial procedure and to assess their suitability for and the potential benefits from the potential revisional surgical options. It will come down to a risk-benefit discussion between the sur-geon, other members of the multidisciplinary support team, and the patient.281Treatment for Insufficient Weight Loss or Weight RegainVertical Banded Gastroplasty. Reversal of VBG is associ-ated with significant weight gain. Revision of the VBG |
Surgery_Schwartz_7938 | Surgery_Schwartz | support team, and the patient.281Treatment for Insufficient Weight Loss or Weight RegainVertical Banded Gastroplasty. Reversal of VBG is associ-ated with significant weight gain. Revision of the VBG to a re-VBG was associated with poor outcomes.292 VBGs have been safely converted with open and laparoscopic approaches to RYGB and SG.293-295 Conversion of VBG to BPD/DS pro-cedures has limited data with higher leak rate and mortality.296Adjustable Gastric Band. There are increasing reports of LAGB failure and disappointing weight loss over the last decade.289,297,298 Removal of the band without an additional bar-iatric procedure has been associated with significant weight regain.289 Repositioning or replacement of the band is techni-cally possible; however, the long-term weight loss outcomes are mixed.299-301 When converting an LAGB to another bariatric pro-cedure, there is some evidence to suggest possibly fewer com-plications with a two-step approach when significant adhesions or a | Surgery_Schwartz. support team, and the patient.281Treatment for Insufficient Weight Loss or Weight RegainVertical Banded Gastroplasty. Reversal of VBG is associ-ated with significant weight gain. Revision of the VBG to a re-VBG was associated with poor outcomes.292 VBGs have been safely converted with open and laparoscopic approaches to RYGB and SG.293-295 Conversion of VBG to BPD/DS pro-cedures has limited data with higher leak rate and mortality.296Adjustable Gastric Band. There are increasing reports of LAGB failure and disappointing weight loss over the last decade.289,297,298 Removal of the band without an additional bar-iatric procedure has been associated with significant weight regain.289 Repositioning or replacement of the band is techni-cally possible; however, the long-term weight loss outcomes are mixed.299-301 When converting an LAGB to another bariatric pro-cedure, there is some evidence to suggest possibly fewer com-plications with a two-step approach when significant adhesions or a |
Surgery_Schwartz_7939 | Surgery_Schwartz | are mixed.299-301 When converting an LAGB to another bariatric pro-cedure, there is some evidence to suggest possibly fewer com-plications with a two-step approach when significant adhesions or a thick gastric capsule are present. This two-step approach would include removal of the band, allowing 3 to 6 months for gastric tissue healing, and then completing the conver-sion.302,303 However, one-stage conversions have been reported with acceptable outcomes.297 Good outcomes have been dem-onstrated with conversion of LAGBs to SG, RYGB, and BPD/DS.285,297 Several investigators advocate that a failed restrictive bariatric surgery due to poor weight loss should include a revi-sion option with a malabsorptive component.285Sleeve Gastrectomy. Approximately 5% to 10% of primary SG procedures have been reported to require revision for poor weight loss outcomes.304,305 The literature supports conversion to RYGB and BPD/DS.306 There is controversy regarding resleeve gastrectomy.307,308Roux-en-Y | Surgery_Schwartz. are mixed.299-301 When converting an LAGB to another bariatric pro-cedure, there is some evidence to suggest possibly fewer com-plications with a two-step approach when significant adhesions or a thick gastric capsule are present. This two-step approach would include removal of the band, allowing 3 to 6 months for gastric tissue healing, and then completing the conver-sion.302,303 However, one-stage conversions have been reported with acceptable outcomes.297 Good outcomes have been dem-onstrated with conversion of LAGBs to SG, RYGB, and BPD/DS.285,297 Several investigators advocate that a failed restrictive bariatric surgery due to poor weight loss should include a revi-sion option with a malabsorptive component.285Sleeve Gastrectomy. Approximately 5% to 10% of primary SG procedures have been reported to require revision for poor weight loss outcomes.304,305 The literature supports conversion to RYGB and BPD/DS.306 There is controversy regarding resleeve gastrectomy.307,308Roux-en-Y |
Surgery_Schwartz_7940 | Surgery_Schwartz | been reported to require revision for poor weight loss outcomes.304,305 The literature supports conversion to RYGB and BPD/DS.306 There is controversy regarding resleeve gastrectomy.307,308Roux-en-Y Gastric Bypass. Approximately, 10% to 20 % of patients after a primary RYGB will have inadequate weight loss or weight regain at 2 years, and a subset of these will require a revisional surgical procedure.309 Options for revision include banding over the Roux-en-Y bypass, gastric pouch and gas-trojejunal revisions, RYGB limb lengthening, and conversion to a duodenal switch.281,285 Each of these options has strengths and weaknesses in specific situations. Endoscopic revisions to reduce the gastric pouch and/or gastrojejunal stomal size have been shown to arrest weight gain with short-term weight loss, but the studies have been small and are noncontrolled.Treatment of Surgical ComplicationsVertical Banded Gastroplasty. Several complications have been indications for revision/conversion of | Surgery_Schwartz. been reported to require revision for poor weight loss outcomes.304,305 The literature supports conversion to RYGB and BPD/DS.306 There is controversy regarding resleeve gastrectomy.307,308Roux-en-Y Gastric Bypass. Approximately, 10% to 20 % of patients after a primary RYGB will have inadequate weight loss or weight regain at 2 years, and a subset of these will require a revisional surgical procedure.309 Options for revision include banding over the Roux-en-Y bypass, gastric pouch and gas-trojejunal revisions, RYGB limb lengthening, and conversion to a duodenal switch.281,285 Each of these options has strengths and weaknesses in specific situations. Endoscopic revisions to reduce the gastric pouch and/or gastrojejunal stomal size have been shown to arrest weight gain with short-term weight loss, but the studies have been small and are noncontrolled.Treatment of Surgical ComplicationsVertical Banded Gastroplasty. Several complications have been indications for revision/conversion of |
Surgery_Schwartz_7941 | Surgery_Schwartz | loss, but the studies have been small and are noncontrolled.Treatment of Surgical ComplicationsVertical Banded Gastroplasty. Several complications have been indications for revision/conversion of VBGs: wide outlet, pouch dilation, staple line erosion, stoma stenosis, band erosion, band dehiscence, and GERD. Most often conversion is under-taken, and VBGs have been safely converted to RYGB.281,285Adjustable Gastric Band. The following LAGB complica-tions may require additional or revisional surgery: early band obstruction, severe or chronic gastric prolapse or symmetrical gastroesophageal dilatation, band erosion, port and tubing prob-lems, severe or persistent esophageal dysmotility, or psycho-logical intolerance to restriction of band. The literature supports repair of tubing and port problems and revision of LAGB to SG, RYGB, BPD/DS in oneor two-stage revisional operations.285,297Sleeve Gastrectomy. Complications that may require a revi-sional procedure after sleeve gastrectomy are | Surgery_Schwartz. loss, but the studies have been small and are noncontrolled.Treatment of Surgical ComplicationsVertical Banded Gastroplasty. Several complications have been indications for revision/conversion of VBGs: wide outlet, pouch dilation, staple line erosion, stoma stenosis, band erosion, band dehiscence, and GERD. Most often conversion is under-taken, and VBGs have been safely converted to RYGB.281,285Adjustable Gastric Band. The following LAGB complica-tions may require additional or revisional surgery: early band obstruction, severe or chronic gastric prolapse or symmetrical gastroesophageal dilatation, band erosion, port and tubing prob-lems, severe or persistent esophageal dysmotility, or psycho-logical intolerance to restriction of band. The literature supports repair of tubing and port problems and revision of LAGB to SG, RYGB, BPD/DS in oneor two-stage revisional operations.285,297Sleeve Gastrectomy. Complications that may require a revi-sional procedure after sleeve gastrectomy are |
Surgery_Schwartz_7942 | Surgery_Schwartz | and revision of LAGB to SG, RYGB, BPD/DS in oneor two-stage revisional operations.285,297Sleeve Gastrectomy. Complications that may require a revi-sional procedure after sleeve gastrectomy are staple line leaks, sleeve stricture and sleeve dilatation, and gastroesophageal reflux. Obstruction due to stricture usually at the angularis inci-sura will require first-line treatment of endoscopic dilation and may require a revision to a RYGB. Staple line leaks are ini-tially controlled with endoscopic stenting or drainage. Acute and chronic leaks may develop into fistulous disease and require conversion to RYGB. Persistent gastroesophageal reflux may also require conversion to RYGB.281,285Roux-en-Y Gastric Bypass. Several complications after pri-mary RYGB have been demonstrated as indications for revi-sional surgery: gastric pouch dilatation, gastrojejunostomy dilation/stricture, marginal ulcers, bowel loss due to internal hernia or volvulus, roux stasis syndrome, gastrogastric fistu-las, | Surgery_Schwartz. and revision of LAGB to SG, RYGB, BPD/DS in oneor two-stage revisional operations.285,297Sleeve Gastrectomy. Complications that may require a revi-sional procedure after sleeve gastrectomy are staple line leaks, sleeve stricture and sleeve dilatation, and gastroesophageal reflux. Obstruction due to stricture usually at the angularis inci-sura will require first-line treatment of endoscopic dilation and may require a revision to a RYGB. Staple line leaks are ini-tially controlled with endoscopic stenting or drainage. Acute and chronic leaks may develop into fistulous disease and require conversion to RYGB. Persistent gastroesophageal reflux may also require conversion to RYGB.281,285Roux-en-Y Gastric Bypass. Several complications after pri-mary RYGB have been demonstrated as indications for revi-sional surgery: gastric pouch dilatation, gastrojejunostomy dilation/stricture, marginal ulcers, bowel loss due to internal hernia or volvulus, roux stasis syndrome, gastrogastric fistu-las, |
Surgery_Schwartz_7943 | Surgery_Schwartz | for revi-sional surgery: gastric pouch dilatation, gastrojejunostomy dilation/stricture, marginal ulcers, bowel loss due to internal hernia or volvulus, roux stasis syndrome, gastrogastric fistu-las, anastomotic structures or ulcers, and metabolic/endocrine derangements. These require a revision focused on the mecha-nism of the complication. Reversal of an RYGB is reserved for severe instances of intractable nausea/vomiting, extreme weight loss and malnutrition, metabolic abnormalities, nonhealing ulceration or leaks, and patient choice. It has been performed rarely, and case reports indicate successful resolution of endo-crine, metabolic, and nutritional abnormalities with improved Brunicardi_Ch27_p1167-p1218.indd 120623/02/19 2:21 PM 1207THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27metabolic parameters. However, 50% to 88% of patients have been reported to regain significant weight.281,285Biliopancreatic Diversion With Duodenal Switch. Acute complications are similar to RYGB and | Surgery_Schwartz. for revi-sional surgery: gastric pouch dilatation, gastrojejunostomy dilation/stricture, marginal ulcers, bowel loss due to internal hernia or volvulus, roux stasis syndrome, gastrogastric fistu-las, anastomotic structures or ulcers, and metabolic/endocrine derangements. These require a revision focused on the mecha-nism of the complication. Reversal of an RYGB is reserved for severe instances of intractable nausea/vomiting, extreme weight loss and malnutrition, metabolic abnormalities, nonhealing ulceration or leaks, and patient choice. It has been performed rarely, and case reports indicate successful resolution of endo-crine, metabolic, and nutritional abnormalities with improved Brunicardi_Ch27_p1167-p1218.indd 120623/02/19 2:21 PM 1207THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27metabolic parameters. However, 50% to 88% of patients have been reported to regain significant weight.281,285Biliopancreatic Diversion With Duodenal Switch. Acute complications are similar to RYGB and |
Surgery_Schwartz_7944 | Surgery_Schwartz | parameters. However, 50% to 88% of patients have been reported to regain significant weight.281,285Biliopancreatic Diversion With Duodenal Switch. Acute complications are similar to RYGB and treated the same. The most severe chronic complication is protein-calorie malnutri-tion, and incidence ranges from 1% to 6%. Management is meticulous nutritional evaluation and nutritional and pancreatic enzyme support, with surgery as a fall back if weight and pro-tein stores are not stabilized. Surgery would entail lengthening the common channel and is rarely necessary.281SPECIAL ISSUES IN BARIATRIC SURGERYBariatric Procedures in AdolescentsThe major controversy with regard to adolescents undergoing bariatric surgery includes the general aversion to subjecting an adolescent to surgery as well as the concern for the second-ary side effects of bariatric surgery on remaining growth and development. Clearly the younger the patient, the more relevant the latter concern becomes. Bariatric surgery in | Surgery_Schwartz. parameters. However, 50% to 88% of patients have been reported to regain significant weight.281,285Biliopancreatic Diversion With Duodenal Switch. Acute complications are similar to RYGB and treated the same. The most severe chronic complication is protein-calorie malnutri-tion, and incidence ranges from 1% to 6%. Management is meticulous nutritional evaluation and nutritional and pancreatic enzyme support, with surgery as a fall back if weight and pro-tein stores are not stabilized. Surgery would entail lengthening the common channel and is rarely necessary.281SPECIAL ISSUES IN BARIATRIC SURGERYBariatric Procedures in AdolescentsThe major controversy with regard to adolescents undergoing bariatric surgery includes the general aversion to subjecting an adolescent to surgery as well as the concern for the second-ary side effects of bariatric surgery on remaining growth and development. Clearly the younger the patient, the more relevant the latter concern becomes. Bariatric surgery in |
Surgery_Schwartz_7945 | Surgery_Schwartz | concern for the second-ary side effects of bariatric surgery on remaining growth and development. Clearly the younger the patient, the more relevant the latter concern becomes. Bariatric surgery in adolescents has been performed more frequently, with only 800 cases a year in 2003 increasing to 1600 cases in 2009, but overall rates are much lower than in adults.310,311 Much of the clinical outcomes data have been extrapolated from the adult literature, and more evidence is needed to demonstrate whether weight loss is dura-ble over time, the impact on obesity-related conditions such as T2DM, hypertension, and others, and how often patients experi-ence shortand longer-term complications.A meta-analysis involving 131 adolescents undergoing bariatric surgery demonstrated a 17.8 to 22.3 kg/m2 decrease in BMI after RYGB.312 They also observed improvement of hyper-tension in more than half the patients and sleep apnea resolution in all 131 patients. There were four mortalities in this cohort, | Surgery_Schwartz. concern for the second-ary side effects of bariatric surgery on remaining growth and development. Clearly the younger the patient, the more relevant the latter concern becomes. Bariatric surgery in adolescents has been performed more frequently, with only 800 cases a year in 2003 increasing to 1600 cases in 2009, but overall rates are much lower than in adults.310,311 Much of the clinical outcomes data have been extrapolated from the adult literature, and more evidence is needed to demonstrate whether weight loss is dura-ble over time, the impact on obesity-related conditions such as T2DM, hypertension, and others, and how often patients experi-ence shortand longer-term complications.A meta-analysis involving 131 adolescents undergoing bariatric surgery demonstrated a 17.8 to 22.3 kg/m2 decrease in BMI after RYGB.312 They also observed improvement of hyper-tension in more than half the patients and sleep apnea resolution in all 131 patients. There were four mortalities in this cohort, |
Surgery_Schwartz_7946 | Surgery_Schwartz | in BMI after RYGB.312 They also observed improvement of hyper-tension in more than half the patients and sleep apnea resolution in all 131 patients. There were four mortalities in this cohort, but only one of them was potentially associated with the pro-cedure (Clostridium difficile colitis 9 months after operation). Morbidity in the adolescent literature ranges from 0% to 38%. The most common complication in the meta-analysis was nutri-ent deficiencies. The ASMBS pediatric guidelines suggest using BMI criteria similar to the adult population but with some modi-fications to comorbidity thresholds.313 They recommend con-sidering surgery in patients with a BMI of 35 kg/m2 or greater with major comorbidities (e.g., T2DM, severe nonalcoholic fatty liver disease, OSA) or a BMI of ≥40 kg/m2 or greater with minor comorbidities (e.g., hypertension, dyslipidemia, insulin resistance). One more recent multicenter, prospective study of bariatric surgery in adolescents, the Teen-Longitudinal | Surgery_Schwartz. in BMI after RYGB.312 They also observed improvement of hyper-tension in more than half the patients and sleep apnea resolution in all 131 patients. There were four mortalities in this cohort, but only one of them was potentially associated with the pro-cedure (Clostridium difficile colitis 9 months after operation). Morbidity in the adolescent literature ranges from 0% to 38%. The most common complication in the meta-analysis was nutri-ent deficiencies. The ASMBS pediatric guidelines suggest using BMI criteria similar to the adult population but with some modi-fications to comorbidity thresholds.313 They recommend con-sidering surgery in patients with a BMI of 35 kg/m2 or greater with major comorbidities (e.g., T2DM, severe nonalcoholic fatty liver disease, OSA) or a BMI of ≥40 kg/m2 or greater with minor comorbidities (e.g., hypertension, dyslipidemia, insulin resistance). One more recent multicenter, prospective study of bariatric surgery in adolescents, the Teen-Longitudinal |
Surgery_Schwartz_7947 | Surgery_Schwartz | or greater with minor comorbidities (e.g., hypertension, dyslipidemia, insulin resistance). One more recent multicenter, prospective study of bariatric surgery in adolescents, the Teen-Longitudinal Assess-ment of Bariatric Surgery (Teen-LABS) study, is following 242 adolescent patients for at least 10 years, who underwent bariatric surgery at 5 academic centers.314 Fifty-one percent of adolescents had four or more major comorbid conditions before surgery. LRYGB, SG, and LAGB were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications such as reoperation were reported in 19 patients (8%). Minor complications such as dehydration were reported in 15%. All reoperations and 85% of readmissions in the 30-day period were related to the bariatric surgery.315 Three-year follow-up data on the Teen-LABS cohort reported a mean weight loss of 28% for LRYGB and 26% for SG. Remission of | Surgery_Schwartz. or greater with minor comorbidities (e.g., hypertension, dyslipidemia, insulin resistance). One more recent multicenter, prospective study of bariatric surgery in adolescents, the Teen-Longitudinal Assess-ment of Bariatric Surgery (Teen-LABS) study, is following 242 adolescent patients for at least 10 years, who underwent bariatric surgery at 5 academic centers.314 Fifty-one percent of adolescents had four or more major comorbid conditions before surgery. LRYGB, SG, and LAGB were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications such as reoperation were reported in 19 patients (8%). Minor complications such as dehydration were reported in 15%. All reoperations and 85% of readmissions in the 30-day period were related to the bariatric surgery.315 Three-year follow-up data on the Teen-LABS cohort reported a mean weight loss of 28% for LRYGB and 26% for SG. Remission of |
Surgery_Schwartz_7948 | Surgery_Schwartz | in the 30-day period were related to the bariatric surgery.315 Three-year follow-up data on the Teen-LABS cohort reported a mean weight loss of 28% for LRYGB and 26% for SG. Remission of T2DM occurred in 95% of participants who had had the con-dition before surgery, remission of abnormal kidney function occurred in 86%, remission of prediabetes in 76%, remission of elevated blood pressure in 74%, and remission of dyslipidemia in 66%. Rates of improvements in comorbid conditions, includ-ing T2DM, occurred at higher rates than in adults. Hypofer-ritinemia was found in 57% of the participants, and 13% of the participants had undergone one or more additional intraabdomi-nal procedures at 3 years.52 So despite the clinically significant improvements in weight, diabetes, cardiometabolic health, and weight-related quality of life that were observed at 3 years fol-lowing surgery, the reoperation and micronutrient risks warrant longer observation and further study.Cost EffectivenessIn a | Surgery_Schwartz. in the 30-day period were related to the bariatric surgery.315 Three-year follow-up data on the Teen-LABS cohort reported a mean weight loss of 28% for LRYGB and 26% for SG. Remission of T2DM occurred in 95% of participants who had had the con-dition before surgery, remission of abnormal kidney function occurred in 86%, remission of prediabetes in 76%, remission of elevated blood pressure in 74%, and remission of dyslipidemia in 66%. Rates of improvements in comorbid conditions, includ-ing T2DM, occurred at higher rates than in adults. Hypofer-ritinemia was found in 57% of the participants, and 13% of the participants had undergone one or more additional intraabdomi-nal procedures at 3 years.52 So despite the clinically significant improvements in weight, diabetes, cardiometabolic health, and weight-related quality of life that were observed at 3 years fol-lowing surgery, the reoperation and micronutrient risks warrant longer observation and further study.Cost EffectivenessIn a |
Surgery_Schwartz_7949 | Surgery_Schwartz | and weight-related quality of life that were observed at 3 years fol-lowing surgery, the reoperation and micronutrient risks warrant longer observation and further study.Cost EffectivenessIn a Canadian study, including five systematic reviews, two eco-nomic evaluations, two reviews of guidelines, and six primary evidence-based guidelines, the cost effectiveness for the use of bariatric surgery in adolescents was reviewed.316 The limited available evidence suggested superior weight loss, resolution of comorbidities compared to nonsurgical interventions, and potential superior weight loss with RYGB compared to other procedures. Cost-effectiveness data was lacking, but limited evidence suggested that bariatric surgery was cost effective several years after intervention, but not immediately.316 A U.S. cost-effectiveness analysis of bariatric surgery in adolescents has been published. In addition to the cost of the surgery, peri-operative mortality, complications, and quality of life | Surgery_Schwartz. and weight-related quality of life that were observed at 3 years fol-lowing surgery, the reoperation and micronutrient risks warrant longer observation and further study.Cost EffectivenessIn a Canadian study, including five systematic reviews, two eco-nomic evaluations, two reviews of guidelines, and six primary evidence-based guidelines, the cost effectiveness for the use of bariatric surgery in adolescents was reviewed.316 The limited available evidence suggested superior weight loss, resolution of comorbidities compared to nonsurgical interventions, and potential superior weight loss with RYGB compared to other procedures. Cost-effectiveness data was lacking, but limited evidence suggested that bariatric surgery was cost effective several years after intervention, but not immediately.316 A U.S. cost-effectiveness analysis of bariatric surgery in adolescents has been published. In addition to the cost of the surgery, peri-operative mortality, complications, and quality of life |
Surgery_Schwartz_7950 | Surgery_Schwartz | A U.S. cost-effectiveness analysis of bariatric surgery in adolescents has been published. In addition to the cost of the surgery, peri-operative mortality, complications, and quality of life improve-ment were included in the modelled analysis. By the fifth year of follow-up, bariatric surgery was found to be cost effective in adolescent patients when compared to a cohort of patients with obesity who had not undergone surgery.317For adults, the overall impact of bariatric surgery to reduce expenditures sufficiently to achieve cost savings continues to be debated. In a Canadian matched cohort study prior to the laparoscopic era, it was shown that bariatric surgery decreases long-term direct healthcare costs and the initial costs of surgery can be amortized over 3.5 years.318 In two observational studies, bariatric surgery was shown to be cost saving over a relatively short period of time.319,320 In more recent observational studies, including the large SOS study and another an analysis | Surgery_Schwartz. A U.S. cost-effectiveness analysis of bariatric surgery in adolescents has been published. In addition to the cost of the surgery, peri-operative mortality, complications, and quality of life improve-ment were included in the modelled analysis. By the fifth year of follow-up, bariatric surgery was found to be cost effective in adolescent patients when compared to a cohort of patients with obesity who had not undergone surgery.317For adults, the overall impact of bariatric surgery to reduce expenditures sufficiently to achieve cost savings continues to be debated. In a Canadian matched cohort study prior to the laparoscopic era, it was shown that bariatric surgery decreases long-term direct healthcare costs and the initial costs of surgery can be amortized over 3.5 years.318 In two observational studies, bariatric surgery was shown to be cost saving over a relatively short period of time.319,320 In more recent observational studies, including the large SOS study and another an analysis |
Surgery_Schwartz_7951 | Surgery_Schwartz | studies, bariatric surgery was shown to be cost saving over a relatively short period of time.319,320 In more recent observational studies, including the large SOS study and another an analysis of 30,000 single payor enrollees in the United States, show no evidence of overall cost savings.206,321,322In general, review of the evidence to date suggests that outpatient costs, including pharmacy costs, are significantly reduced after bariatric surgery. However, long-term inpatient hospital costs are increased or unchanged in those who have undergone bariatric surgery compared with matched nonsurgi-cal patients, so no long-term net cost benefit is achieved. Other modeled cost effectiveness studies are consistent with these results as well.323,324 So it is likely that bariatric procedures are cost effective, but do not produce cost savings, compared with nonsurgical treatments.Quality AssuranceBetween 1998 and 2003, with emergence of the laparoscopic technique for bariatric surgery, there | Surgery_Schwartz. studies, bariatric surgery was shown to be cost saving over a relatively short period of time.319,320 In more recent observational studies, including the large SOS study and another an analysis of 30,000 single payor enrollees in the United States, show no evidence of overall cost savings.206,321,322In general, review of the evidence to date suggests that outpatient costs, including pharmacy costs, are significantly reduced after bariatric surgery. However, long-term inpatient hospital costs are increased or unchanged in those who have undergone bariatric surgery compared with matched nonsurgi-cal patients, so no long-term net cost benefit is achieved. Other modeled cost effectiveness studies are consistent with these results as well.323,324 So it is likely that bariatric procedures are cost effective, but do not produce cost savings, compared with nonsurgical treatments.Quality AssuranceBetween 1998 and 2003, with emergence of the laparoscopic technique for bariatric surgery, there |
Surgery_Schwartz_7952 | Surgery_Schwartz | cost effective, but do not produce cost savings, compared with nonsurgical treatments.Quality AssuranceBetween 1998 and 2003, with emergence of the laparoscopic technique for bariatric surgery, there was rapid increase in the number bariatric surgical procedures performed. With bariatric surgeons becoming accustomed to laparoscopic techniques and laparoscopic surgeons learning bariatric procedures and patient care, there were realistic concerns regarding the safety of bar-iatric surgery.325 In 2004, ASMBS utilized the volume-outcome concept of centers of excellence and developed the first bar-iatric surgical accreditation program, ASMBS-Center of Excel-lence (COE). In 2005, the American College of Surgeons (ACS) initiated the ACS Bariatric Surgery Center Network (BSCN). Brunicardi_Ch27_p1167-p1218.indd 120723/02/19 2:21 PM 1208SPECIFIC CONSIDERATIONSPART IIThese accreditation programs verified that bariatric surgery centers had the infrastructure and equipment to care for the | Surgery_Schwartz. cost effective, but do not produce cost savings, compared with nonsurgical treatments.Quality AssuranceBetween 1998 and 2003, with emergence of the laparoscopic technique for bariatric surgery, there was rapid increase in the number bariatric surgical procedures performed. With bariatric surgeons becoming accustomed to laparoscopic techniques and laparoscopic surgeons learning bariatric procedures and patient care, there were realistic concerns regarding the safety of bar-iatric surgery.325 In 2004, ASMBS utilized the volume-outcome concept of centers of excellence and developed the first bar-iatric surgical accreditation program, ASMBS-Center of Excel-lence (COE). In 2005, the American College of Surgeons (ACS) initiated the ACS Bariatric Surgery Center Network (BSCN). Brunicardi_Ch27_p1167-p1218.indd 120723/02/19 2:21 PM 1208SPECIFIC CONSIDERATIONSPART IIThese accreditation programs verified that bariatric surgery centers had the infrastructure and equipment to care for the |
Surgery_Schwartz_7953 | Surgery_Schwartz | 120723/02/19 2:21 PM 1208SPECIFIC CONSIDERATIONSPART IIThese accreditation programs verified that bariatric surgery centers had the infrastructure and equipment to care for the morbidly obese, experienced and qualified surgeons and staff, appropriate preand postoperative processes in place, and reported outcome data on all surgical cases.325In 2012, these two bariatric surgical accreditations merged into a single unified program, the Metabolic and Bar-iatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). The MBSAQIP has continued to grant accredita-tion only after a rigorous review process during which a center proves that it can maintain certain physical resources, human resources, and standards of practice.326 Additionally, prospec-tive outcome data is collected at the clinical center and validated based on standardized definitions and submitted to the quality improvement program. Centers receive back risk-stratified anal-ysis of their data as a means to | Surgery_Schwartz. 120723/02/19 2:21 PM 1208SPECIFIC CONSIDERATIONSPART IIThese accreditation programs verified that bariatric surgery centers had the infrastructure and equipment to care for the morbidly obese, experienced and qualified surgeons and staff, appropriate preand postoperative processes in place, and reported outcome data on all surgical cases.325In 2012, these two bariatric surgical accreditations merged into a single unified program, the Metabolic and Bar-iatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). The MBSAQIP has continued to grant accredita-tion only after a rigorous review process during which a center proves that it can maintain certain physical resources, human resources, and standards of practice.326 Additionally, prospec-tive outcome data is collected at the clinical center and validated based on standardized definitions and submitted to the quality improvement program. Centers receive back risk-stratified anal-ysis of their data as a means to |
Surgery_Schwartz_7954 | Surgery_Schwartz | at the clinical center and validated based on standardized definitions and submitted to the quality improvement program. Centers receive back risk-stratified anal-ysis of their data as a means to compare with the national statis-tics/standards and are then required to utilize the data in quality improvement projects at their center. This newer focus on qual-ity improvement over centers of excellence will likely continue to improve the quality of bariatric surgery in the United States. Recently, in a systematic review, bariatric facility accreditation by this program has been associated with improved outcomes (length of stay, mortality, morbidity).327Plastic Surgery After Weight LossPatients who have undergone bariatric surgery are often left with skin and subcutaneous tissue deformities. Additional prob-lems include skin rashes and maceration under folds in the pan-nus, thighs, and breasts; body odor; and poorly fitting clothes. Excess skin can also be a limiting factor in exercise | Surgery_Schwartz. at the clinical center and validated based on standardized definitions and submitted to the quality improvement program. Centers receive back risk-stratified anal-ysis of their data as a means to compare with the national statis-tics/standards and are then required to utilize the data in quality improvement projects at their center. This newer focus on qual-ity improvement over centers of excellence will likely continue to improve the quality of bariatric surgery in the United States. Recently, in a systematic review, bariatric facility accreditation by this program has been associated with improved outcomes (length of stay, mortality, morbidity).327Plastic Surgery After Weight LossPatients who have undergone bariatric surgery are often left with skin and subcutaneous tissue deformities. Additional prob-lems include skin rashes and maceration under folds in the pan-nus, thighs, and breasts; body odor; and poorly fitting clothes. Excess skin can also be a limiting factor in exercise |
Surgery_Schwartz_7955 | Surgery_Schwartz | Additional prob-lems include skin rashes and maceration under folds in the pan-nus, thighs, and breasts; body odor; and poorly fitting clothes. Excess skin can also be a limiting factor in exercise and sexual activity. Plastic and reconstructive surgery is now a part of the continuum of care for bariatric surgery patients. Reconstructive surgery requires careful preoperative planning and is based on the patient’s deformities and priorities. Timing of plastic and reconstructive surgery is typically deferred until weight sta-bility at approximately 1 to 2 years postoperatively to ensure improved healing. Excess tissue of the lower torso is the most common area for which patients undergo surgical intervention and a standard abdominoplasty is typically performed. More radical body contouring can include a circumferential abdomi-noplasty and lower body lift.328,329 This procedure involves excision of tissue from the buttocks and lateral thighs, with skin undermining down the thighs. | Surgery_Schwartz. Additional prob-lems include skin rashes and maceration under folds in the pan-nus, thighs, and breasts; body odor; and poorly fitting clothes. Excess skin can also be a limiting factor in exercise and sexual activity. Plastic and reconstructive surgery is now a part of the continuum of care for bariatric surgery patients. Reconstructive surgery requires careful preoperative planning and is based on the patient’s deformities and priorities. Timing of plastic and reconstructive surgery is typically deferred until weight sta-bility at approximately 1 to 2 years postoperatively to ensure improved healing. Excess tissue of the lower torso is the most common area for which patients undergo surgical intervention and a standard abdominoplasty is typically performed. More radical body contouring can include a circumferential abdomi-noplasty and lower body lift.328,329 This procedure involves excision of tissue from the buttocks and lateral thighs, with skin undermining down the thighs. |
Surgery_Schwartz_7956 | Surgery_Schwartz | can include a circumferential abdomi-noplasty and lower body lift.328,329 This procedure involves excision of tissue from the buttocks and lateral thighs, with skin undermining down the thighs. Circumferential abdomino-plasty removes redundant skin of the lower abdomen, flattens the abdomen, and incorporates the lower body lift. It requires central undermining to the xiphoid and minimal lateral under-mining of the superior flap. The central abdominal fascia often requires imbrication. If simultaneous abdominal hernia repair is performed, this performs the function of fascial imbrication by creating a repair with some degree of fascial tension. The closure of the superior flap to the inferior skin edge incorporates lateral tension to narrow the waist and advance the anterolateral thighs. Medial thighplasty also may be needed for patients with significant excess medial thigh skin.Mid-back and epigastric deformity, along with sagging breasts, are corrected with an upper body lift. The | Surgery_Schwartz. can include a circumferential abdomi-noplasty and lower body lift.328,329 This procedure involves excision of tissue from the buttocks and lateral thighs, with skin undermining down the thighs. Circumferential abdomino-plasty removes redundant skin of the lower abdomen, flattens the abdomen, and incorporates the lower body lift. It requires central undermining to the xiphoid and minimal lateral under-mining of the superior flap. The central abdominal fascia often requires imbrication. If simultaneous abdominal hernia repair is performed, this performs the function of fascial imbrication by creating a repair with some degree of fascial tension. The closure of the superior flap to the inferior skin edge incorporates lateral tension to narrow the waist and advance the anterolateral thighs. Medial thighplasty also may be needed for patients with significant excess medial thigh skin.Mid-back and epigastric deformity, along with sagging breasts, are corrected with an upper body lift. The |
Surgery_Schwartz_7957 | Surgery_Schwartz | Medial thighplasty also may be needed for patients with significant excess medial thigh skin.Mid-back and epigastric deformity, along with sagging breasts, are corrected with an upper body lift. The upper body lift is a reverse abdominoplasty, removal of mid-torso excessive skin, and reshaping of the breasts. For highly selected individu-als, and with a well-organized team, a single-stage total body lift, which includes a circumferential abdominoplasty, lower body lift, medial thighplasty, an upper body lift, and breast reshap-ing, can be performed safely in under 8 hours (Figs. 27-30 and 27-31).330 Increasing numbers of patients are seeking these cor-rective procedures, and data about the results is evolving. There Figure 27-30. Preoperative frontal, right lateral, and left anterior oblique views of a 36-year-old, 150-lb (68-kg) 5'6" woman who lost 120 lb (54 kg) 2 years after laparoscopic Roux-en-Y bypass procedure. She desired a one-stage total body lift and bilateral | Surgery_Schwartz. Medial thighplasty also may be needed for patients with significant excess medial thigh skin.Mid-back and epigastric deformity, along with sagging breasts, are corrected with an upper body lift. The upper body lift is a reverse abdominoplasty, removal of mid-torso excessive skin, and reshaping of the breasts. For highly selected individu-als, and with a well-organized team, a single-stage total body lift, which includes a circumferential abdominoplasty, lower body lift, medial thighplasty, an upper body lift, and breast reshap-ing, can be performed safely in under 8 hours (Figs. 27-30 and 27-31).330 Increasing numbers of patients are seeking these cor-rective procedures, and data about the results is evolving. There Figure 27-30. Preoperative frontal, right lateral, and left anterior oblique views of a 36-year-old, 150-lb (68-kg) 5'6" woman who lost 120 lb (54 kg) 2 years after laparoscopic Roux-en-Y bypass procedure. She desired a one-stage total body lift and bilateral |
Surgery_Schwartz_7958 | Surgery_Schwartz | oblique views of a 36-year-old, 150-lb (68-kg) 5'6" woman who lost 120 lb (54 kg) 2 years after laparoscopic Roux-en-Y bypass procedure. She desired a one-stage total body lift and bilateral brachioplasties, which were performed in the manner described in the text. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)Brunicardi_Ch27_p1167-p1218.indd 120823/02/19 2:21 PM 1209THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Figure 27-31. Frontal, right lateral, and left anterior oblique views 6 weeks after surgery for the woman in Fig. 27-24. The scars indicate the circumferential abdominoplasty, lower body lift, upper body lift, breast reshaping, and autoaugmentation through a keyhole pattern and bilateral brachioplasties. All redundant skin has been removed, leaving well-positioned scars and feminine features. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)is a | Surgery_Schwartz. oblique views of a 36-year-old, 150-lb (68-kg) 5'6" woman who lost 120 lb (54 kg) 2 years after laparoscopic Roux-en-Y bypass procedure. She desired a one-stage total body lift and bilateral brachioplasties, which were performed in the manner described in the text. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)Brunicardi_Ch27_p1167-p1218.indd 120823/02/19 2:21 PM 1209THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27Figure 27-31. Frontal, right lateral, and left anterior oblique views 6 weeks after surgery for the woman in Fig. 27-24. The scars indicate the circumferential abdominoplasty, lower body lift, upper body lift, breast reshaping, and autoaugmentation through a keyhole pattern and bilateral brachioplasties. All redundant skin has been removed, leaving well-positioned scars and feminine features. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)is a |
Surgery_Schwartz_7959 | Surgery_Schwartz | skin has been removed, leaving well-positioned scars and feminine features. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)is a hypothesis that if body image is improved with corrective surgery, that weight maintenance in the longer-term may also be positively affected. Several matched controlled studies suggest that plastic surgery after bariatric surgery may improve long-term weight loss results.328,331FUTURE IMPORTANT QUESTIONSThe volume and quality of literature in the field of bariatric sur-gery has grown tremendously in the last 10 years. High-quality evidence now shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments, improved sur-vival, and are more effective at inducing remission of T2DM in people with obesity. More information is still needed about the long-term durability of comorbid health improvements and long-term complications after each of the different | Surgery_Schwartz. skin has been removed, leaving well-positioned scars and feminine features. (Used with permission from Dennis Hurwitz, MD, Clinical Professor of Plastic Surgery, University of Pittsburgh.)is a hypothesis that if body image is improved with corrective surgery, that weight maintenance in the longer-term may also be positively affected. Several matched controlled studies suggest that plastic surgery after bariatric surgery may improve long-term weight loss results.328,331FUTURE IMPORTANT QUESTIONSThe volume and quality of literature in the field of bariatric sur-gery has grown tremendously in the last 10 years. High-quality evidence now shows that bariatric surgical procedures result in greater weight loss than nonsurgical treatments, improved sur-vival, and are more effective at inducing remission of T2DM in people with obesity. More information is still needed about the long-term durability of comorbid health improvements and long-term complications after each of the different |
Surgery_Schwartz_7960 | Surgery_Schwartz | remission of T2DM in people with obesity. More information is still needed about the long-term durability of comorbid health improvements and long-term complications after each of the different bar-iatric surgical procedures. In addition, the underlying specific mechanism(s) of action for both bariatric and metabolic surgery is still incompletely understood. Future knowledge will come from translational human studies, the ongoing longer-term stud-ies and data registries, randomized studies comparing surgical to nonsurgical treatments, integrated health care systems data, and national “big data” networks. The following are some of the high-priority questions that future research will address.• What are the specific mechanisms of action responsible for weight loss and the T2DM response to bariatric surgical procedures?• What patient level factors can predict success with weight loss, health improvements, and cost savings after bariatric surgical procedures? Understanding preand | Surgery_Schwartz. remission of T2DM in people with obesity. More information is still needed about the long-term durability of comorbid health improvements and long-term complications after each of the different bar-iatric surgical procedures. In addition, the underlying specific mechanism(s) of action for both bariatric and metabolic surgery is still incompletely understood. Future knowledge will come from translational human studies, the ongoing longer-term stud-ies and data registries, randomized studies comparing surgical to nonsurgical treatments, integrated health care systems data, and national “big data” networks. The following are some of the high-priority questions that future research will address.• What are the specific mechanisms of action responsible for weight loss and the T2DM response to bariatric surgical procedures?• What patient level factors can predict success with weight loss, health improvements, and cost savings after bariatric surgical procedures? Understanding preand |
Surgery_Schwartz_7961 | Surgery_Schwartz | to bariatric surgical procedures?• What patient level factors can predict success with weight loss, health improvements, and cost savings after bariatric surgical procedures? Understanding preand postsurgery predictors will help to tailor an individual’s treatment.• Is bariatric surgery more effective than nonsurgical care for the longer-term treatment of T2DM in people with less severe obesity (class 1 obesity, BMI <35)?• With more standardized reporting of complications across bariatric studies, what are the long-term complication rates after different bariatric procedures?• What is the effect of bariatric surgery on long-term microvas-cular and macrovascular event rates?• What are the reproductive and mental health outcomes includ-ing risk for self-harm and suicide, alcohol use disorders, sub-stance abuse, and other risk-taking behaviors?REFERENCESEntries highlighted in bright blue are key references. 1. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic | Surgery_Schwartz. to bariatric surgical procedures?• What patient level factors can predict success with weight loss, health improvements, and cost savings after bariatric surgical procedures? Understanding preand postsurgery predictors will help to tailor an individual’s treatment.• Is bariatric surgery more effective than nonsurgical care for the longer-term treatment of T2DM in people with less severe obesity (class 1 obesity, BMI <35)?• With more standardized reporting of complications across bariatric studies, what are the long-term complication rates after different bariatric procedures?• What is the effect of bariatric surgery on long-term microvas-cular and macrovascular event rates?• What are the reproductive and mental health outcomes includ-ing risk for self-harm and suicide, alcohol use disorders, sub-stance abuse, and other risk-taking behaviors?REFERENCESEntries highlighted in bright blue are key references. 1. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic |
Surgery_Schwartz_7962 | Surgery_Schwartz | sub-stance abuse, and other risk-taking behaviors?REFERENCESEntries highlighted in bright blue are key references. 1. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961. 2. Kremen AJ, Linner JH, Nelson CH. An experimental evalua-tion of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954;140(3):439-448. 3. Mason EE, Ito C. Gastric bypass. Ann Surg. 1969;170(3): 329-339. 4. Griffen WO Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977;186(4):500-509. 5. Mason EE. Vertical banded gastroplasty for obesity. Arch Surg. 1982;117(5):701-706. 6. Brolin RE, Robertson LB, Kenler HA, Cody RP. Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg. 1994;220(6):782-790. 7. Waaddegaard P, Clemmesen T, Jess P. Vertical gastric banding for morbid obesity: a long-term follow-up | Surgery_Schwartz. sub-stance abuse, and other risk-taking behaviors?REFERENCESEntries highlighted in bright blue are key references. 1. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961. 2. Kremen AJ, Linner JH, Nelson CH. An experimental evalua-tion of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954;140(3):439-448. 3. Mason EE, Ito C. Gastric bypass. Ann Surg. 1969;170(3): 329-339. 4. Griffen WO Jr, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977;186(4):500-509. 5. Mason EE. Vertical banded gastroplasty for obesity. Arch Surg. 1982;117(5):701-706. 6. Brolin RE, Robertson LB, Kenler HA, Cody RP. Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg. 1994;220(6):782-790. 7. Waaddegaard P, Clemmesen T, Jess P. Vertical gastric banding for morbid obesity: a long-term follow-up |
Surgery_Schwartz_7963 | Surgery_Schwartz | vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg. 1994;220(6):782-790. 7. Waaddegaard P, Clemmesen T, Jess P. Vertical gastric banding for morbid obesity: a long-term follow-up study. Eur J Surg. 2002;168(4):220-222.Brunicardi_Ch27_p1167-p1218.indd 120923/02/19 2:21 PM 1210SPECIFIC CONSIDERATIONSPART II 8. Balsiger BM, Poggio JL, Mai J, Kelly KA, Sarr MG. Ten and more years after vertical banded gastroplasty as pri-mary operation for morbid obesity. J Gastrointest Surg. 2000;4(6):598-605. 9. Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66(9):618-620. 10. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267-282. 11. Belachew M, Legrand MJ, Defechereux TH, Burtheret MP, Jacquet N. Laparoscopic adjustable silicone gastric band-ing in the treatment of morbid obesity. A preliminary report. Surg Endosc. | Surgery_Schwartz. vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg. 1994;220(6):782-790. 7. Waaddegaard P, Clemmesen T, Jess P. Vertical gastric banding for morbid obesity: a long-term follow-up study. Eur J Surg. 2002;168(4):220-222.Brunicardi_Ch27_p1167-p1218.indd 120923/02/19 2:21 PM 1210SPECIFIC CONSIDERATIONSPART II 8. Balsiger BM, Poggio JL, Mai J, Kelly KA, Sarr MG. Ten and more years after vertical banded gastroplasty as pri-mary operation for morbid obesity. J Gastrointest Surg. 2000;4(6):598-605. 9. Scopinaro N, Gianetta E, Civalleri D, Bonalumi U, Bachi V. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66(9):618-620. 10. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267-282. 11. Belachew M, Legrand MJ, Defechereux TH, Burtheret MP, Jacquet N. Laparoscopic adjustable silicone gastric band-ing in the treatment of morbid obesity. A preliminary report. Surg Endosc. |
Surgery_Schwartz_7964 | Surgery_Schwartz | M, Legrand MJ, Defechereux TH, Burtheret MP, Jacquet N. Laparoscopic adjustable silicone gastric band-ing in the treatment of morbid obesity. A preliminary report. Surg Endosc. 1994;8(11):1354-1356. 12. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4(4):353-357. 13. Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA. 2014;312(9):959-961. 14. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279-2289. 15. Shimizu H, Timratana P, Schauer PR, Rogula T. Review of metabolic surgery for type 2 diabetes in patients with a BMI <35 kg/m2. J Obes. 2012;2012:147256. 16. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabet Care. | Surgery_Schwartz. M, Legrand MJ, Defechereux TH, Burtheret MP, Jacquet N. Laparoscopic adjustable silicone gastric band-ing in the treatment of morbid obesity. A preliminary report. Surg Endosc. 1994;8(11):1354-1356. 12. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4(4):353-357. 13. Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA. 2014;312(9):959-961. 14. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279-2289. 15. Shimizu H, Timratana P, Schauer PR, Rogula T. Review of metabolic surgery for type 2 diabetes in patients with a BMI <35 kg/m2. J Obes. 2012;2012:147256. 16. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabet Care. |
Surgery_Schwartz_7965 | Surgery_Schwartz | 2012;2012:147256. 16. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabet Care. 2016;39(6):861-877. This paper summarizes the most recent Diabetes Surgery Summit (DSS-II) conclusions for which three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. Based on the evidence, bariatric/metabolic surgery was recommended to treat Type 2 diabetes in patients with Class III obesity (BMI≥40 kg/m2) and in those with Class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 (Class I obesity) if hyperglycemia is inadequately controlled despite optimal medical treatment. 17. Stefater MA, Wilson-Perez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: | Surgery_Schwartz. 2012;2012:147256. 16. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabet Care. 2016;39(6):861-877. This paper summarizes the most recent Diabetes Surgery Summit (DSS-II) conclusions for which three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. Based on the evidence, bariatric/metabolic surgery was recommended to treat Type 2 diabetes in patients with Class III obesity (BMI≥40 kg/m2) and in those with Class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 (Class I obesity) if hyperglycemia is inadequately controlled despite optimal medical treatment. 17. Stefater MA, Wilson-Perez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: |
Surgery_Schwartz_7966 | Surgery_Schwartz | if hyperglycemia is inadequately controlled despite optimal medical treatment. 17. Stefater MA, Wilson-Perez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev. 2012;33(4):595-622. This paper is a review of what is known from published animal and human studies about the underlying basic mechanisms of effect of each of 3 most common surgical procedures. This review forms the basis of why research has shifted away from anatomic characterizations of the bariatric procedures as either “restrictive” or “malabsorptive” in nature, towards the physiology of common metabolic changes. 18. World Health Organization. Obesity and overweight. Avail-able at: http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed June 13, 2018. 19. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245. 20. Flegal KM, Kruszon-Moran D, Carroll MD, | Surgery_Schwartz. if hyperglycemia is inadequately controlled despite optimal medical treatment. 17. Stefater MA, Wilson-Perez HE, Chambers AP, Sandoval DA, Seeley RJ. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev. 2012;33(4):595-622. This paper is a review of what is known from published animal and human studies about the underlying basic mechanisms of effect of each of 3 most common surgical procedures. This review forms the basis of why research has shifted away from anatomic characterizations of the bariatric procedures as either “restrictive” or “malabsorptive” in nature, towards the physiology of common metabolic changes. 18. World Health Organization. Obesity and overweight. Avail-able at: http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed June 13, 2018. 19. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245. 20. Flegal KM, Kruszon-Moran D, Carroll MD, |
Surgery_Schwartz_7967 | Surgery_Schwartz | Accessed June 13, 2018. 19. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245. 20. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. 21. Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292-2299. 22. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254-266. 23. Bray MS LR, McCaffery JM, et al. NIH working group report—using genomic information to guide weight management: from universal to precision treatment. Obesity (Silver Spring). 2016;24(1):14-22. 24. Pigeyre M, Yazdi FT, Kaur Y, Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci. 2016;130(12): | Surgery_Schwartz. Accessed June 13, 2018. 19. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1245. 20. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. 21. Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292-2299. 22. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254-266. 23. Bray MS LR, McCaffery JM, et al. NIH working group report—using genomic information to guide weight management: from universal to precision treatment. Obesity (Silver Spring). 2016;24(1):14-22. 24. Pigeyre M, Yazdi FT, Kaur Y, Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci. 2016;130(12): |
Surgery_Schwartz_7968 | Surgery_Schwartz | Spring). 2016;24(1):14-22. 24. Pigeyre M, Yazdi FT, Kaur Y, Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci. 2016;130(12): 943-986. 25. Shen W, Wang Z, Punyanita M, et al. Adipose tissue quanti-fication by imaging methods: a proposed classification. Obes Res. 2003;11(1):5-16. 26. Tchkonia T, Thomou T, Zhu Y, et al. Mechanisms and meta-bolic implications of regional differences among fat depots. Cell Metab. 2013;17(5):644-656. 27. Hall JE, da Silva AA, do Carmo JM, et al. Obesity-induced hypertension: role of sympathetic nervous system, leptin, and melanocortins. J Biol Chem. 2010;285(23):17271-17276. 28. Ashrafian H, Toma T, Rowland SP, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239-1250. 29. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. | Surgery_Schwartz. Spring). 2016;24(1):14-22. 24. Pigeyre M, Yazdi FT, Kaur Y, Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci. 2016;130(12): 943-986. 25. Shen W, Wang Z, Punyanita M, et al. Adipose tissue quanti-fication by imaging methods: a proposed classification. Obes Res. 2003;11(1):5-16. 26. Tchkonia T, Thomou T, Zhu Y, et al. Mechanisms and meta-bolic implications of regional differences among fat depots. Cell Metab. 2013;17(5):644-656. 27. Hall JE, da Silva AA, do Carmo JM, et al. Obesity-induced hypertension: role of sympathetic nervous system, leptin, and melanocortins. J Biol Chem. 2010;285(23):17271-17276. 28. Ashrafian H, Toma T, Rowland SP, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239-1250. 29. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. |
Surgery_Schwartz_7969 | Surgery_Schwartz | for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239-1250. 29. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011;23(5):471-478. 30. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its com-plications. Ann Intern Med. 2005;143(3):199-211. 31. Berkowitz RI, Fabricatore AN. Obesity, psychiatric status, and psychiatric medications. Psychiatr Clin North Amer. 2011;34(4):747-764. 32. Mitchell JE, Selzer F, Kalarchian MA, et al. Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis. 2012;8(5):533-541. 33. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Obesity. 2006;14(suppl 2):53S-62S. 34. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College | Surgery_Schwartz. for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239-1250. 29. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011;23(5):471-478. 30. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its com-plications. Ann Intern Med. 2005;143(3):199-211. 31. Berkowitz RI, Fabricatore AN. Obesity, psychiatric status, and psychiatric medications. Psychiatr Clin North Amer. 2011;34(4):747-764. 32. Mitchell JE, Selzer F, Kalarchian MA, et al. Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis. 2012;8(5):533-541. 33. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Obesity. 2006;14(suppl 2):53S-62S. 34. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College |
Surgery_Schwartz_7970 | Surgery_Schwartz | bariatric surgery: a patient-oriented approach. Obesity. 2006;14(suppl 2):53S-62S. 34. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203. 35. American College of Cardiology/American Heart Association Task Force on practice guidelines OEP. Expert panel report: guidelines (2013) for the management of overweight and obesity in adults. Obesity. 2014;22(suppl 2):S41-S410. 36. Look ARG, Pi-Sunyer X, Blackburn G, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabet Care. 2007;30(6):1374-1383. 37. Look ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. | Surgery_Schwartz. bariatric surgery: a patient-oriented approach. Obesity. 2006;14(suppl 2):53S-62S. 34. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203. 35. American College of Cardiology/American Heart Association Task Force on practice guidelines OEP. Expert panel report: guidelines (2013) for the management of overweight and obesity in adults. Obesity. 2014;22(suppl 2):S41-S410. 36. Look ARG, Pi-Sunyer X, Blackburn G, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabet Care. 2007;30(6):1374-1383. 37. Look ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. |
Surgery_Schwartz_7971 | Surgery_Schwartz | ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17): 1566-1575. 38. Look ARG, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N England J Med. 2013;369(2):145-154. 39. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N England J Med. 2002;346(6):393-403. 40. Teixeira PJ, Silva MN, Coutinho SR, et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity. 2010;18(4):725-735. 41. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2): 342-362. 42. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical | Surgery_Schwartz. ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17): 1566-1575. 38. Look ARG, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N England J Med. 2013;369(2):145-154. 39. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N England J Med. 2002;346(6):393-403. 40. Teixeira PJ, Silva MN, Coutinho SR, et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity. 2010;18(4):725-735. 41. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2): 342-362. 42. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical |
Surgery_Schwartz_7972 | Surgery_Schwartz | obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2): 342-362. 42. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014; 311(1):74-86.Brunicardi_Ch27_p1167-p1218.indd 121023/02/19 2:21 PM 1211THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27 43. Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N England J Med. 2015;373(1):11-22. 44. Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA. 1999;281(3):235-242. 45. Smith SR, Weissman NJ, Anderson CM, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N England J Med. 2010;363(3):245-256. 46. Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and | Surgery_Schwartz. obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2): 342-362. 42. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014; 311(1):74-86.Brunicardi_Ch27_p1167-p1218.indd 121023/02/19 2:21 PM 1211THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27 43. Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N England J Med. 2015;373(1):11-22. 44. Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA. 1999;281(3):235-242. 45. Smith SR, Weissman NJ, Anderson CM, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N England J Med. 2010;363(3):245-256. 46. Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and |
Surgery_Schwartz_7973 | Surgery_Schwartz | for weight management. N England J Med. 2010;363(3):245-256. 46. Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341-1352. 47. Apovian CM, Aronne L, Rubino D, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity. 2013;21(5):935-943. 48. Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424-2434. 49. ASMBS. Estimate of bariatric surgery numbers, 2011-2016. Available at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed June 13, 2018. 50. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and | Surgery_Schwartz. for weight management. N England J Med. 2010;363(3):245-256. 46. Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341-1352. 47. Apovian CM, Aronne L, Rubino D, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity. 2013;21(5):935-943. 48. Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424-2434. 49. ASMBS. Estimate of bariatric surgery numbers, 2011-2016. Available at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed June 13, 2018. 50. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and |
Surgery_Schwartz_7974 | Surgery_Schwartz | at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed June 13, 2018. 50. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12(9):1637-1639. 51. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956-961. 52. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N England J Med. 2016;374(2):113-123. 53. Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis. World J Surg. 2014;38(5):1121-1126. 54. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627-1635. 55. Casillas RA, Kim B, Fischer | Surgery_Schwartz. at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed June 13, 2018. 50. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12(9):1637-1639. 51. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956-961. 52. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N England J Med. 2016;374(2):113-123. 53. Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis. World J Surg. 2014;38(5):1121-1126. 54. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627-1635. 55. Casillas RA, Kim B, Fischer |
Surgery_Schwartz_7975 | Surgery_Schwartz | World J Surg. 2014;38(5):1121-1126. 54. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627-1635. 55. Casillas RA, Kim B, Fischer H, Zelada Getty JL, Um SS, Coleman KJ. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Relat Dis. 2017; 13(9):1476-1483. 56. Flum DR, Salem L, Elrod JA, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bar-iatric surgical procedures. JAMA. 2005;294(15):1903-1908. 57. Davidson LE, Adams TD, Kim J, et al. Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality. JAMA. 2016;151(7):631-637. 58. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association | Surgery_Schwartz. World J Surg. 2014;38(5):1121-1126. 54. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627-1635. 55. Casillas RA, Kim B, Fischer H, Zelada Getty JL, Um SS, Coleman KJ. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Relat Dis. 2017; 13(9):1476-1483. 56. Flum DR, Salem L, Elrod JA, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bar-iatric surgical procedures. JAMA. 2005;294(15):1903-1908. 57. Davidson LE, Adams TD, Kim J, et al. Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality. JAMA. 2016;151(7):631-637. 58. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association |
Surgery_Schwartz_7976 | Surgery_Schwartz | Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Soci-ety for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159-191. 59. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N England J Med. 2009;361(5):445-454. This is a 30 day safety paper from the Longitudinal Assessment of Bariatric Surgery (LABS-1) study. It is a definitive paper on the morbidity and mortality of bariatric surgery from a multi-center and carefully studied cohort of patients undergoing bariatric surgery. The 30-day mortality was 0.3% for all procedures with a major adverse outcome rate [a pre-defined composite endpoint that included; death, venous thromboembolism, re-intervention (percutaneous, endoscopic, or operative), or failure | Surgery_Schwartz. Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Soci-ety for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159-191. 59. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N England J Med. 2009;361(5):445-454. This is a 30 day safety paper from the Longitudinal Assessment of Bariatric Surgery (LABS-1) study. It is a definitive paper on the morbidity and mortality of bariatric surgery from a multi-center and carefully studied cohort of patients undergoing bariatric surgery. The 30-day mortality was 0.3% for all procedures with a major adverse outcome rate [a pre-defined composite endpoint that included; death, venous thromboembolism, re-intervention (percutaneous, endoscopic, or operative), or failure |
Surgery_Schwartz_7977 | Surgery_Schwartz | all procedures with a major adverse outcome rate [a pre-defined composite endpoint that included; death, venous thromboembolism, re-intervention (percutaneous, endoscopic, or operative), or failure to be discharged from the hospital in 30 days] of 4.1%. 60. Cummings BP, Strader AD, Stanhope KL, et al. Ileal inter-position surgery improves glucose and lipid metabolism and delays diabetes onset in the UCD-T2DM rat. Gastroenterology. 2010;138(7):2437-2446, 2446 e2431. 61. Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240(2):236-242. 62. Strader AD, Vahl TP, Jandacek RJ, Woods SC, D’Alessio DA, Seeley RJ. Weight loss through ileal transposition is accompa-nied by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005;288(2):E447-E453. 63. Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and | Surgery_Schwartz. all procedures with a major adverse outcome rate [a pre-defined composite endpoint that included; death, venous thromboembolism, re-intervention (percutaneous, endoscopic, or operative), or failure to be discharged from the hospital in 30 days] of 4.1%. 60. Cummings BP, Strader AD, Stanhope KL, et al. Ileal inter-position surgery improves glucose and lipid metabolism and delays diabetes onset in the UCD-T2DM rat. Gastroenterology. 2010;138(7):2437-2446, 2446 e2431. 61. Rubino F, Gagner M, Gentileschi P, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240(2):236-242. 62. Strader AD, Vahl TP, Jandacek RJ, Woods SC, D’Alessio DA, Seeley RJ. Weight loss through ileal transposition is accompa-nied by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005;288(2):E447-E453. 63. Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and |
Surgery_Schwartz_7978 | Surgery_Schwartz | by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005;288(2):E447-E453. 63. Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol. 2014;2(2):152-164. 64. Ochner CN, Stice E, Hutchins E, et al. Relation between changes in neural responsivity and reductions in desire to eat high-calorie foods following gastric bypass surgery. Neuroscience. 2012;209:128-135. 65. Chakravarty PD, McLaughlin E, Whittaker D, et al. Compari-son of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the ran-domised controlled trials. Surgeon. 2012;10(3):172-182. 66. Liou AP, Paziuk M, Luevano JM, Jr., Machineni S, Turnbaugh PJ, Kaplan LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra141. 67. Sweeney TE, Morton JM. The human gut microbiome: a review | Surgery_Schwartz. by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005;288(2):E447-E453. 63. Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol. 2014;2(2):152-164. 64. Ochner CN, Stice E, Hutchins E, et al. Relation between changes in neural responsivity and reductions in desire to eat high-calorie foods following gastric bypass surgery. Neuroscience. 2012;209:128-135. 65. Chakravarty PD, McLaughlin E, Whittaker D, et al. Compari-son of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the ran-domised controlled trials. Surgeon. 2012;10(3):172-182. 66. Liou AP, Paziuk M, Luevano JM, Jr., Machineni S, Turnbaugh PJ, Kaplan LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra141. 67. Sweeney TE, Morton JM. The human gut microbiome: a review |
Surgery_Schwartz_7979 | Surgery_Schwartz | LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra141. 67. Sweeney TE, Morton JM. The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg. 2013;148(6):563-569. 68. Jones N. Gut-microbe swap helps mice shed weight. Bacte-ria transplant provides some of the benefits of gastric bypass surgery without the surgery. Nature. 2013 Mar. doi:10.1038/nature.2013.12688. JNG-mshmswBtpsotbogbswtsNM. 69. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastro Surg. 2009;13(7):1198-1204. 70. Kohli R, Bradley D, Setchell KD, Eagon JC, Abumrad N, Klein S. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98(4): E708-E712. 71. Porez G, Prawitt J, Gross B, Staels B. | Surgery_Schwartz. LM. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra141. 67. Sweeney TE, Morton JM. The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg. 2013;148(6):563-569. 68. Jones N. Gut-microbe swap helps mice shed weight. Bacte-ria transplant provides some of the benefits of gastric bypass surgery without the surgery. Nature. 2013 Mar. doi:10.1038/nature.2013.12688. JNG-mshmswBtpsotbogbswtsNM. 69. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastro Surg. 2009;13(7):1198-1204. 70. Kohli R, Bradley D, Setchell KD, Eagon JC, Abumrad N, Klein S. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98(4): E708-E712. 71. Porez G, Prawitt J, Gross B, Staels B. |
Surgery_Schwartz_7980 | Surgery_Schwartz | Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98(4): E708-E712. 71. Porez G, Prawitt J, Gross B, Staels B. Bile acid receptors as targets for the treatment of dyslipidemia and cardiovascular disease. J Lipid Res. 2012;53(9):1723-1737. 72. De Giorgi S, Campos V, Egli L, et al. Long-term effects of Roux-en-Y gastric bypass on postprandial plasma lipid and bile acids kinetics in female non diabetic subjects: a cross-sectional pilot study. Clin Nutr. 2015;34(5):911-917. 73. Kohli R, Myronovych A, Tan BK, et al. Bile acid signaling: mechanism for bariatric surgery, cure for NASH? Digest Dis. 2015;33(3):440-446. 74. Ryan KK, Tremaroli V, Clemmensen C, et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature. 2014;509(7499):183-188. 75. Hollanda A et al. Variability of weight loss results with Roux-en-Y gastric bypass, Editorial comment. Surgery for Obesity and Related | Surgery_Schwartz. Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab. 2013;98(4): E708-E712. 71. Porez G, Prawitt J, Gross B, Staels B. Bile acid receptors as targets for the treatment of dyslipidemia and cardiovascular disease. J Lipid Res. 2012;53(9):1723-1737. 72. De Giorgi S, Campos V, Egli L, et al. Long-term effects of Roux-en-Y gastric bypass on postprandial plasma lipid and bile acids kinetics in female non diabetic subjects: a cross-sectional pilot study. Clin Nutr. 2015;34(5):911-917. 73. Kohli R, Myronovych A, Tan BK, et al. Bile acid signaling: mechanism for bariatric surgery, cure for NASH? Digest Dis. 2015;33(3):440-446. 74. Ryan KK, Tremaroli V, Clemmensen C, et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature. 2014;509(7499):183-188. 75. Hollanda A et al. Variability of weight loss results with Roux-en-Y gastric bypass, Editorial comment. Surgery for Obesity and Related |
Surgery_Schwartz_7981 | Surgery_Schwartz | vertical sleeve gastrectomy. Nature. 2014;509(7499):183-188. 75. Hollanda A et al. Variability of weight loss results with Roux-en-Y gastric bypass, Editorial comment. Surgery for Obesity and Related Diseases. 2014; 10: 814-821.. 76. Collaboration NCDRF. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027): 1513-1530. 77. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316-323.Brunicardi_Ch27_p1167-p1218.indd 121123/02/19 2:21 PM 1212SPECIFIC CONSIDERATIONSPART II 78. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567-1576. 79. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. | Surgery_Schwartz. vertical sleeve gastrectomy. Nature. 2014;509(7499):183-188. 75. Hollanda A et al. Variability of weight loss results with Roux-en-Y gastric bypass, Editorial comment. Surgery for Obesity and Related Diseases. 2014; 10: 814-821.. 76. Collaboration NCDRF. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027): 1513-1530. 77. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316-323.Brunicardi_Ch27_p1167-p1218.indd 121123/02/19 2:21 PM 1212SPECIFIC CONSIDERATIONSPART II 78. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567-1576. 79. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. |
Surgery_Schwartz_7982 | Surgery_Schwartz | patients with diabetes. N Engl J Med. 2012;366(17):1567-1576. 79. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577-1585. 80. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240-2249. 81. Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945-953. 82. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973. This is a randomized clinical | Surgery_Schwartz. patients with diabetes. N Engl J Med. 2012;366(17):1567-1576. 79. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577-1585. 80. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240-2249. 81. Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945-953. 82. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973. This is a randomized clinical |
Surgery_Schwartz_7983 | Surgery_Schwartz | medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973. This is a randomized clinical trial comparing gastric bypass, biliopancreatic diversion, and medical treatment for the treatment of type 2 diabetes in people with obesity. It is only one of 2 randomized studies addressing this question with 5 year follow up, at this time. 83. Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7): 716-726. 84. Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA Surg. 2014;149(7):707-715. 85. Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastric band surgery or medical management in patients with type 2 | Surgery_Schwartz. medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973. This is a randomized clinical trial comparing gastric bypass, biliopancreatic diversion, and medical treatment for the treatment of type 2 diabetes in people with obesity. It is only one of 2 randomized studies addressing this question with 5 year follow up, at this time. 83. Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7): 716-726. 84. Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA Surg. 2014;149(7):707-715. 85. Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastric band surgery or medical management in patients with type 2 |
Surgery_Schwartz_7984 | Surgery_Schwartz | mellitus: a randomized clinical trial. JAMA Surg. 2014;149(7):707-715. 85. Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastric band surgery or medical management in patients with type 2 diabetes: a randomized clinical trial. J Clin Endocrinol Metab. 2015;100(7):2546-2556. 86. Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931-940. 87. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339-350; discussion 350-332. 88. Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intes-tinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341(6144):406-410. 89. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, | Surgery_Schwartz. mellitus: a randomized clinical trial. JAMA Surg. 2014;149(7):707-715. 85. Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastric band surgery or medical management in patients with type 2 diabetes: a randomized clinical trial. J Clin Endocrinol Metab. 2015;100(7):2546-2556. 86. Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931-940. 87. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339-350; discussion 350-332. 88. Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intes-tinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341(6144):406-410. 89. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, |
Surgery_Schwartz_7985 | Surgery_Schwartz | and glycemic control in rats after gastric bypass. Science. 2013;341(6144):406-410. 89. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clini-cal Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(suppl 1):S1-S27. This is a comprehensive set of guidelines for the perioperative care of the bariatric surgery patient with references to much of the current literature sup-porting these recommendations. 90. Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry. 2010;23(1):30-36. 91. Heinberg LJ, Ashton K, Windover A. Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery. Surg Obes Relat Dis. | Surgery_Schwartz. and glycemic control in rats after gastric bypass. Science. 2013;341(6144):406-410. 89. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clini-cal Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(suppl 1):S1-S27. This is a comprehensive set of guidelines for the perioperative care of the bariatric surgery patient with references to much of the current literature sup-porting these recommendations. 90. Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry. 2010;23(1):30-36. 91. Heinberg LJ, Ashton K, Windover A. Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery. Surg Obes Relat Dis. |
Surgery_Schwartz_7986 | Surgery_Schwartz | LJ, Ashton K, Windover A. Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery. Surg Obes Relat Dis. 2010;6(2):185-190. 92. Greenberg I, Sogg S, F MP. Behavioral and psychological care in weight loss surgery: best practice update. Obesity. 2009;17(5):880-884. 93. Mahony D. Psychological assessments of bariatric sur-gery patients. Development, reliability, and exploratory factor analysis of the PsyBari. Obes Surg. 2011;21(9): 1395-1406. 94. Fabricatore AN, Crerand CE, Wadden TA, Sarwer DB, Krasucki JL. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16(5):567-573. 95. Mitchell JE, Steffen KJ, de Zwaan M, Ertelt TW, Marino JM, Mueller A. Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly | Surgery_Schwartz. LJ, Ashton K, Windover A. Moving beyond dichotomous psychological evaluation: the Cleveland Clinic Behavioral Rating System for weight loss surgery. Surg Obes Relat Dis. 2010;6(2):185-190. 92. Greenberg I, Sogg S, F MP. Behavioral and psychological care in weight loss surgery: best practice update. Obesity. 2009;17(5):880-884. 93. Mahony D. Psychological assessments of bariatric sur-gery patients. Development, reliability, and exploratory factor analysis of the PsyBari. Obes Surg. 2011;21(9): 1395-1406. 94. Fabricatore AN, Crerand CE, Wadden TA, Sarwer DB, Krasucki JL. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16(5):567-573. 95. Mitchell JE, Steffen KJ, de Zwaan M, Ertelt TW, Marino JM, Mueller A. Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly |
Surgery_Schwartz_7987 | Surgery_Schwartz | clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL, LaMonte MJ, Walker JM, Cloward TV, Davidson LE, Crosby RD. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7(5):605-610. 98. Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809-814. 99. Palla A, Digiorgio M, Carpene N, et al. Sleep apnea in mor-bidly obese patients: prevalence and clinical predictivity. Respiration. 2009;78(2):134-140. 100. Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. | Surgery_Schwartz. clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL, LaMonte MJ, Walker JM, Cloward TV, Davidson LE, Crosby RD. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7(5):605-610. 98. Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809-814. 99. Palla A, Digiorgio M, Carpene N, et al. Sleep apnea in mor-bidly obese patients: prevalence and clinical predictivity. Respiration. 2009;78(2):134-140. 100. Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. |
Surgery_Schwartz_7988 | Surgery_Schwartz | NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10(2):226-232. 102. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079-1085. 103. Schumann R, Jones SB, Cooper B, et al. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004-2007. Obesity. 2009;17(5):889-894. 104. Fritscher LG, Mottin CC, Canani S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17(1):95-99. 105. Fris RJ. Preoperative low energy diet diminishes liver size. | Surgery_Schwartz. NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10(2):226-232. 102. Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079-1085. 103. Schumann R, Jones SB, Cooper B, et al. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004-2007. Obesity. 2009;17(5):889-894. 104. Fritscher LG, Mottin CC, Canani S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17(1):95-99. 105. Fris RJ. Preoperative low energy diet diminishes liver size. |
Surgery_Schwartz_7989 | Surgery_Schwartz | S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17(1):95-99. 105. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14(9):1165-1170. 106. Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345-350. 107. Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146(11):1300-1305. 108. Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1282-1286. 109. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. | Surgery_Schwartz. S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17(1):95-99. 105. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14(9):1165-1170. 106. Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345-350. 107. Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146(11):1300-1305. 108. Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1282-1286. 109. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. |
Surgery_Schwartz_7990 | Surgery_Schwartz | bypass. Obes Surg. 2005;15(9):1282-1286. 109. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2): 141-145; discussion 145-146. 110. Frutos MD, Morales MD, Lujan J, Hernandez Q, Valero G, Parrilla P. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17(2):150-154. 111. Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7(4):480-485.Brunicardi_Ch27_p1167-p1218.indd 121223/02/19 2:21 PM 1213THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27 112. Becouarn G, Topart P, Ritz P. Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg. 2010;20(5):574-577. 113. Mosko JD, Nguyen GC. Increased | Surgery_Schwartz. bypass. Obes Surg. 2005;15(9):1282-1286. 109. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2): 141-145; discussion 145-146. 110. Frutos MD, Morales MD, Lujan J, Hernandez Q, Valero G, Parrilla P. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17(2):150-154. 111. Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7(4):480-485.Brunicardi_Ch27_p1167-p1218.indd 121223/02/19 2:21 PM 1213THE SURGICAL MANAGEMENT OF OBESITYCHAPTER 27 112. Becouarn G, Topart P, Ritz P. Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg. 2010;20(5):574-577. 113. Mosko JD, Nguyen GC. Increased |
Surgery_Schwartz_7991 | Surgery_Schwartz | G, Topart P, Ritz P. Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg. 2010;20(5):574-577. 113. Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897-901. 114. Geerts A, Darius T, Chapelle T, et al. The multicenter Belgian survey on liver transplantation for hepatocellular failure after bariatric surgery. Transplant Proc. 2010;42(10):4395-4398. 115. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American association of clinical endocrinologists and American college of endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21(suppl 1):1-87. 116. Winegar DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes | Surgery_Schwartz. G, Topart P, Ritz P. Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg. 2010;20(5):574-577. 113. Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897-901. 114. Geerts A, Darius T, Chapelle T, et al. The multicenter Belgian survey on liver transplantation for hepatocellular failure after bariatric surgery. Transplant Proc. 2010;42(10):4395-4398. 115. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American association of clinical endocrinologists and American college of endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21(suppl 1):1-87. 116. Winegar DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes |
Surgery_Schwartz_7992 | Surgery_Schwartz | DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2011;7(2):181-188. 117. Birkmeyer NJ, Share D, Baser O, et al. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252(2):313-318. 118. Rowland SP, Dharmarajah B, Moore HM, et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg. 2015;261(1):35-45. 119. Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9): 814-824. 120. Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed | Surgery_Schwartz. DA, Sherif B, Pate V, DeMaria EJ. Venous thromboembolism after bariatric surgery performed by Bariatric Surgery Center of Excellence Participants: analysis of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2011;7(2):181-188. 117. Birkmeyer NJ, Share D, Baser O, et al. Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery. Ann Surg. 2010;252(2):313-318. 118. Rowland SP, Dharmarajah B, Moore HM, et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg. 2015;261(1):35-45. 119. Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9): 814-824. 120. Kominiarek MA, Jungheim ES, Hoeger KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed |
Surgery_Schwartz_7993 | Surgery_Schwartz | KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis. 2017;13(5):750-757. 121. Gosman GG, King WC, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94(4):1426-1431. 122. Eggers C, Obliers R, Koerfer A, et al. A multimedia tool for the informed consent of patients prior to gastric banding. Obesity. 2007;15(11):2866-2873. 123. Arterburn DE, Westbrook EO, Bogart TA, Sepucha KR, Bock SN, Weppner WG. Randomized trial of a video-based patient decision aid for bariatric surgery. Obesity. 2011;19(8):1669-1675. 124. Arterburn D, Flum DR, Westbrook EO, et al. A population-based, shared decision-making approach to recruit for a ran-domized trial of bariatric surgery versus lifestyle for type 2 diabetes. | Surgery_Schwartz. KM, Rogers AM, Kahan S, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society. Surg Obes Relat Dis. 2017;13(5):750-757. 121. Gosman GG, King WC, Schrope B, et al. Reproductive health of women electing bariatric surgery. Fertil Steril. 2010;94(4):1426-1431. 122. Eggers C, Obliers R, Koerfer A, et al. A multimedia tool for the informed consent of patients prior to gastric banding. Obesity. 2007;15(11):2866-2873. 123. Arterburn DE, Westbrook EO, Bogart TA, Sepucha KR, Bock SN, Weppner WG. Randomized trial of a video-based patient decision aid for bariatric surgery. Obesity. 2011;19(8):1669-1675. 124. Arterburn D, Flum DR, Westbrook EO, et al. A population-based, shared decision-making approach to recruit for a ran-domized trial of bariatric surgery versus lifestyle for type 2 diabetes. |
Surgery_Schwartz_7994 | Surgery_Schwartz | D, Flum DR, Westbrook EO, et al. A population-based, shared decision-making approach to recruit for a ran-domized trial of bariatric surgery versus lifestyle for type 2 diabetes. Surg Obes Relat Dis. 2013;9(6):837-844. 125. Sutton D, Spiekermann BF, Bogdonoff DL, Leisure GS, Mathes DD, eds. Perioperative Care: Anesthesia, Medicine and Surgery. 1st ed. St. Louis: Mosby; 1998:547-558. 126. Pisarska M, Malczak P, Major P, Wysocki M, Budzynski A, Pedziwiatr M. Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis. PloS One. 2017;12(3):e0174382. 127. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065-2083. 128. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279-289; discussion | Surgery_Schwartz. D, Flum DR, Westbrook EO, et al. A population-based, shared decision-making approach to recruit for a ran-domized trial of bariatric surgery versus lifestyle for type 2 diabetes. Surg Obes Relat Dis. 2013;9(6):837-844. 125. Sutton D, Spiekermann BF, Bogdonoff DL, Leisure GS, Mathes DD, eds. Perioperative Care: Anesthesia, Medicine and Surgery. 1st ed. St. Louis: Mosby; 1998:547-558. 126. Pisarska M, Malczak P, Major P, Wysocki M, Budzynski A, Pedziwiatr M. Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis. PloS One. 2017;12(3):e0174382. 127. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065-2083. 128. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279-289; discussion |
Surgery_Schwartz_7995 | Surgery_Schwartz | NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279-289; discussion 289-291. 129. Hutter MM, Randall S, Khuri SF, Henderson WG, Abbott WM, Warshaw AL. Laparoscopic versus open gastric bypass for morbid obesity: a multicenter, prospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Ann Surg. 2006;243(5):657-662; discussion 662-656. 130. Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a ran-domized prospective study. Ann Surg. 2004;239(4):433-437. 131. Li K, Zou J, Tang J, Di J, Han X, Zhang P. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2016;26(12):3031-3044. 132. Villamere J, Gebhart A, Vu S, Nguyen NT. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at academic medical | Surgery_Schwartz. NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279-289; discussion 289-291. 129. Hutter MM, Randall S, Khuri SF, Henderson WG, Abbott WM, Warshaw AL. Laparoscopic versus open gastric bypass for morbid obesity: a multicenter, prospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Ann Surg. 2006;243(5):657-662; discussion 662-656. 130. Lujan JA, Frutos MD, Hernandez Q, et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a ran-domized prospective study. Ann Surg. 2004;239(4):433-437. 131. Li K, Zou J, Tang J, Di J, Han X, Zhang P. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2016;26(12):3031-3044. 132. Villamere J, Gebhart A, Vu S, Nguyen NT. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at academic medical |
Surgery_Schwartz_7996 | Surgery_Schwartz | Obes Surg. 2016;26(12):3031-3044. 132. Villamere J, Gebhart A, Vu S, Nguyen NT. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at academic medical centers. Surg Endosc. 2015;29(7):1729-1736. 133. Ayloo SM, Addeo P, Buchs NC, Shah G, Giulianotti PC. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg. 2011;35(3):637-642. 134. Economopoulos KP, Theocharidis V, McKenzie TJ, Sergentanis TN, Psaltopoulou T. Robotic vs. laparoscopic roux-en-y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2015;25(11):2180-2189. 135. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231(4):524-528. 136. Brolin RE, Kenler HA, Gorman JH, Cody RP. Long-limb gas-tric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215(4):387-395. 137. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric | Surgery_Schwartz. Obes Surg. 2016;26(12):3031-3044. 132. Villamere J, Gebhart A, Vu S, Nguyen NT. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at academic medical centers. Surg Endosc. 2015;29(7):1729-1736. 133. Ayloo SM, Addeo P, Buchs NC, Shah G, Giulianotti PC. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg. 2011;35(3):637-642. 134. Economopoulos KP, Theocharidis V, McKenzie TJ, Sergentanis TN, Psaltopoulou T. Robotic vs. laparoscopic roux-en-y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2015;25(11):2180-2189. 135. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231(4):524-528. 136. Brolin RE, Kenler HA, Gorman JH, Cody RP. Long-limb gas-tric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215(4):387-395. 137. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric |
Surgery_Schwartz_7997 | Surgery_Schwartz | gas-tric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215(4):387-395. 137. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, ran-domized clinical trial. Obes Surg. 2002;12(4):540-545. 138. Schirmer BD Lee SK, Northup CJ, et al. Gastrojejunal anastomosis stenosis is lower using linear rather than circular stapling during Roux-en-Y gastric bypass. Presented at SAGES 2006 scientific session, April 2006. 139. Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD. Gastrojejunostomy during laparoscopic gastric bypass: analy-sis of 3 techniques. Arch Surg. 2003;138(2):181-184. 140. Hutter MM, Schirmer BD, Jones DB, et al. 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. Ann Surg. 2011;254(3):410-420; discussion 420-412. 141. DeMaria EJ, Pate V, Warthen M, | Surgery_Schwartz. gas-tric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215(4):387-395. 137. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, ran-domized clinical trial. Obes Surg. 2002;12(4):540-545. 138. Schirmer BD Lee SK, Northup CJ, et al. Gastrojejunal anastomosis stenosis is lower using linear rather than circular stapling during Roux-en-Y gastric bypass. Presented at SAGES 2006 scientific session, April 2006. 139. Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD. Gastrojejunostomy during laparoscopic gastric bypass: analy-sis of 3 techniques. Arch Surg. 2003;138(2):181-184. 140. Hutter MM, Schirmer BD, Jones DB, et al. 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. Ann Surg. 2011;254(3):410-420; discussion 420-412. 141. DeMaria EJ, Pate V, Warthen M, |
Surgery_Schwartz_7998 | Surgery_Schwartz | laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410-420; discussion 420-412. 141. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery— designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6(4):347-355. 142. Masoomi H, Kim H, Reavis KM, Mills S, Stamos MJ, Nguyen NT. Analysis of factors predictive of gastrointestinal tract leak in laparoscopic and open gastric bypass. Arch Surg. 2011;146(9):1048-1051. 143. Finks JF, English WJ, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255(6):1100-1104. 144. Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. | Surgery_Schwartz. laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410-420; discussion 420-412. 141. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery— designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6(4):347-355. 142. Masoomi H, Kim H, Reavis KM, Mills S, Stamos MJ, Nguyen NT. Analysis of factors predictive of gastrointestinal tract leak in laparoscopic and open gastric bypass. Arch Surg. 2011;146(9):1048-1051. 143. Finks JF, English WJ, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255(6):1100-1104. 144. Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. |
Surgery_Schwartz_7999 | Surgery_Schwartz | Collaborative. Ann Surg. 2012;255(6):1100-1104. 144. Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460-463. 145. Parakh S, Soto E, Merola S. Diagnosis and management of internal hernias after laparoscopic gastric bypass. Obes Surg. 2007;17(11):1498-1502. 146. Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62-65. 147. Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705. 148. Clements RH, Yellumahanthi K, Wesley M, Ballem N, Bland KI. Hyperparathyroidism and vitamin D deficiency after Brunicardi_Ch27_p1167-p1218.indd 121323/02/19 2:21 PM 1214SPECIFIC CONSIDERATIONSPART IIlaparoscopic gastric bypass. Am Surg. 2008;74(6):469-474; discussion | Surgery_Schwartz. Collaborative. Ann Surg. 2012;255(6):1100-1104. 144. Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460-463. 145. Parakh S, Soto E, Merola S. Diagnosis and management of internal hernias after laparoscopic gastric bypass. Obes Surg. 2007;17(11):1498-1502. 146. Nguyen NT, Rivers R, Wolfe BM. Early gastrointestinal hemorrhage after laparoscopic gastric bypass. Obes Surg. 2003;13(1):62-65. 147. Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705. 148. Clements RH, Yellumahanthi K, Wesley M, Ballem N, Bland KI. Hyperparathyroidism and vitamin D deficiency after Brunicardi_Ch27_p1167-p1218.indd 121323/02/19 2:21 PM 1214SPECIFIC CONSIDERATIONSPART IIlaparoscopic gastric bypass. Am Surg. 2008;74(6):469-474; discussion |
Surgery_Schwartz_8000 | Surgery_Schwartz | and vitamin D deficiency after Brunicardi_Ch27_p1167-p1218.indd 121323/02/19 2:21 PM 1214SPECIFIC CONSIDERATIONSPART IIlaparoscopic gastric bypass. Am Surg. 2008;74(6):469-474; discussion 474-465. 149. Abu-Elmagd KM, Costa G, McMichael D, et al. Autologous reconstruction and visceral transplantation for management of patients with gut failure after bariatric surgery: 20 years of experience. Ann Surg. 2015;262(4):586-601. 150. Vance PL, de Lange EE, Shaffer HA, Jr., Schirmer B. Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation. Radiology. 2002;222(1):70-72. 151. Thodiyil PA, Yenumula P, Rogula T, et al. Selective nonoperative management of leaks after gastric bypass: lessons learned from 2675 consecutive patients. Ann Surg. 2008;248(5):782-792. 152. Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot | Surgery_Schwartz. and vitamin D deficiency after Brunicardi_Ch27_p1167-p1218.indd 121323/02/19 2:21 PM 1214SPECIFIC CONSIDERATIONSPART IIlaparoscopic gastric bypass. Am Surg. 2008;74(6):469-474; discussion 474-465. 149. Abu-Elmagd KM, Costa G, McMichael D, et al. Autologous reconstruction and visceral transplantation for management of patients with gut failure after bariatric surgery: 20 years of experience. Ann Surg. 2015;262(4):586-601. 150. Vance PL, de Lange EE, Shaffer HA, Jr., Schirmer B. Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation. Radiology. 2002;222(1):70-72. 151. Thodiyil PA, Yenumula P, Rogula T, et al. Selective nonoperative management of leaks after gastric bypass: lessons learned from 2675 consecutive patients. Ann Surg. 2008;248(5):782-792. 152. Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot |
Surgery_Schwartz_8001 | Surgery_Schwartz | Surg. 2008;248(5):782-792. 152. Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2005;1(4):418-422; discussion 422-413. 153. Hamoui N, Crookes PF, Kaufman HS. Percutaneous gastric drainage as a treatment for small bowel obstruction after gastric bypass. Obes Surg. 2007;17(10):1411-1412. 154. Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17(7):962-969. 155. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492-497. 156. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231-237. 157. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Sleeve | Surgery_Schwartz. Surg. 2008;248(5):782-792. 152. Awais O, Raftopoulos I, Luketich JD, Courcoulas A. Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2005;1(4):418-422; discussion 422-413. 153. Hamoui N, Crookes PF, Kaufman HS. Percutaneous gastric drainage as a treatment for small bowel obstruction after gastric bypass. Obes Surg. 2007;17(10):1411-1412. 154. Gumbs AA, Gagner M, Dakin G, Pomp A. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17(7):962-969. 155. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492-497. 156. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231-237. 157. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Sleeve |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.