Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.

Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.

Background: Long-term results of gastric bypass in patients followed for longer than 10 years is not reported in the literature.

Methods: Accurate weights were recorded on 228 of 272 (83.

Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.

Objective: This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients.

Background: Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown.

Long- or short-limb gastric bypass?

The aim of this study was to determine whether longer limb length improved results of gastric bypass in patients who were morbidly obese (body mass index <50 kg/m(2)) or superobese (body mass index >50 kg/m(2). A total of 242 patients were followed for a mean of 5.5 years.

Norman Bethune and Edward Archibald: sung and unsung heroes.

Edward Archibald was a pioneer, master thoracic surgeon. He laid the foundation for surgical research in Canada and made fundamental contributions to the training and certification of surgeons. He did it all without raising his voice and within the confines of organized medicine.

Late outcome of isolated gastric bypass.

Objective: To complete a long-term (>5 years) follow-up of patients undergoing isolated gastric bypass for severe obesity.

Summary Background Data: Previous experience as well as randomized trials suggested that the ideal operation for obesity should rely on manipulation of satiety rather than the production of malabsorption. Such an operation should incorporate a small gastric pouch of less than 30 mL placed in a dependent position on the lesser curvature of the stomach, not dependent on staples, and separated from the remaining stomach with a retrocolic, retrogastric Roux-en-Y gastrojejunostomy without external support.

Iron absorption and therapy after gastric bypass.

Background: Iron deficiency anemia is a common complication of gastric bypass. The authors assessed the value of taking vitamin C with oral iron in correcting deficiencies in iron stores and anemia postoperatively.

Materials And Methods: Iron absorption tests were performed on 55 patients 3.

Exercise capacity and energy expenditure of morbidly obese and previously obese subjects.

Objective: To determine whether morbidly obese and previously obese women fail to lose weight after gastric bypass surgery because of reduced energy expenditure, and whether a large, surgically induced, rapid weight loss improves exercise capacity on a treadmill.

Design: Cross-sectional study.

Participants: Four groups of 5 subjects: 1) patients still obese 12 months after surgery (failure); 2) patients who achieved normal weight after surgery (success); 3) obese patients who had not yet undergone surgery (preoperative); and 4) nonobese (control) subjects.

Stomal ulcer after gastric bypass.

Background: Stomal ulcer is a serious complication of gastrogastric fistula following Roux-en-Y gastric bypass for obesity.

Study Design: A 1-8 year continuous followup of 499 patients with gastric bypass in continuity (GB) and isolated gastric bypass (IGB) documented the incidence of fistula formation, development of stomal ulcer, stimulation of acid production within the gastric pouch, and response to treatment.

Results: In 123 GB patients, staple line disruption occurred in 36 (29%) and stomal ulcer occurred in 20 (16%).

Vitamin B-12 deficiency after gastric surgery for obesity.

Low serum vitamin B-12 concentrations after gastric bypass (GB) surgery for obesity were observed in 11 of 28 patients without detectable impairment of crystalline vitamin B-12 absorption. This was observed in 2 of 19 patients with vertical banded gastroplasty (VBG). In contrast, protein-bound vitamin B-12 absorption was markedly impaired, as demonstrated in eight of these patients after GB (n = 7) and VBG (n = 1).

The delayed hypersensitivity response and host resistance in surgical patients. 20 years later.

Objective: A 20-year follow-up was conducted on research into the implications of a lack of a delayed-type hypersensitivity (DTH) skin test response among surgical patients.

Summary Background Data: The authors' original report showed that a failed DTH response was associated with increased hospital mortality, but the role of specific and nonspecific host defense elements, comorbid factors, nutritional supplementation, and the mechanism for anergy in this adverse outcome was unknown.

Methods: A data base of 4292 patients was analyzed and reported on individual studies designed to answer some of the above questions.

Treatment of Vitamin B12 Deficiency after Gastric Surgery for Severe Obesity.

BACKGROUND: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12, from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin B12 was most effective in treating vitamin B12 deficiency in 102 patients. METHODS AND RESULTS: At time of entry into the study, the patients had a serum vitamin B12, < 100 pmol L(1), were 29.

Surgery for Obesity- An Update of a Randomized Trial.

BACKGROUND: A prospective, randomized trial comparing vertical banded gastroplasty (VBG) and gastric bypass (GB) was performed on 106 patients between 1987 and 1990. METHODS AND RESULTS: Failures of these two operations (manifested by failure to lose weight, late weight gain or intolerance of adequate oral intake) were treated by means of a third operation, isolated gastric bypass (IGB), in which the small gastric pouch was isolated from the gastric fundus. The latter operation was significantly better than VBG or GB and achieved a 63% success rate, i.

Health care delivery and the training of surgeons.

Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical.

A gastroplasty that avoids stapling in continuity.

Background: Staple line perforations have been the principal cause of failure after vertical-banded gastroplasty in patients followed at least 4 years at our institution. In the present study an operation was devised that created a vertical-banded gastroplasty not dependent on staple lines to avoid this complication.

Methods: One hundred two patients with a body mass index (BMI) greater than 35 kg/m2 underwent vertical-banded gastroplasty from Jan.

Regional differences in triacylglycerol synthesis in adipose tissue and in cultured preadipocytes.

The initial suspicion that obesity increases coronary risk has been much sharpened with the demonstration that risk is more tightly linked to abdominal than to peripheral obesity, and tighter yet again when the mass of omental adipose tissue is taken into account. These data suggest that important metabolic differences might exist between adipocytes from different regions, and indeed, it has long been appreciated that triacylglycerol hydrolysis can be stimulated to a greater extent in omental than in subcutaneous adipocytes. The present study focuses on triacylglycerol synthesis in human subcutaneous and omental adipocytes, a process which, by contrast, has received relatively little attention.

Results of the surgical treatment of obesity.

A prospective, randomized trial comparing vertical banded gastroplasty (VBG) and vertical gastric bypass (GB) for obesity was completed in 106 patients who did not differ in baseline body mass index (BMI = kg/m2) or length of follow-up. The goal of this surgery was to return patients to within 50% of their ideal weight, i.e.

Assessment of cardiac function in patients who were morbidly obese.

Cardiac function of 30 patients who were morbidly obese was studied before bariatric surgery. Twelve patients were studied 13 +/- 4 months after surgery. These patients had a mean age of 37.

Late results of vertical banded gastroplasty for morbid and super obesity.

Two hundred one patients who underwent vertical banded gastroplasty have been followed up for a minimum of 2 years to more than 5 years. Staple line perforations occurred in 48% of patients, and 36% underwent reoperation. The instability of the operation becomes apparent only with careful follow-up.

Antibiotic prophylaxis for surgery in morbidly obese patients.

The rate of wound infections in morbidly obese patients who underwent gastroplasty surgery at our institution was 16.5% compared with a rate of 2.5% in normal-weight patients who underwent clean-contaminated surgery.