Causes of 30-day bariatric surgery mortality: with emphasis on bypass obstruction.

Background: This is a study of the causes of 30-day postoperative death following surgical treatment for obesity and a search for ways to decrease an already low mortality rate.

Methods: Data were contributed from 1986-2004 to the International Bariatric Surgery Registry by 85 sites, representing 137 surgeons. A spread-sheet was prepared with rows for causes and columns for patients.

Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry.

Background: The epidemic of morbid obesity has increased bariatric procedures performed. Trend analyses provide important information that may impact individual practices.

Methods: Patient data from 137 surgeons were examined from 1987 to 2004 (41,860 patients) using Cochran-Armitage Trend test and Generalized Linear Model.

Factors influencing survival following surgical treatment of obesity.

Background: The prevalence of obesity in the United States and the surgical treatment of obesity have increased since 1999. An important measure of outcome following surgical treatment is survival.

Methods: This study began with data prospectively collected from Jan 1, 1986 to Dec 31, 1999 by 55 data collection sites, representing 77 surgeons who used standardized data collection software developed by the International Bariatric Surgery Registry (IBSR).

Gallbladder management in obesity surgery.

Background: In the 1980s, some surgeons recommended routine cholecystectomy for patients undergoing bariatric surgery. This was based on the high prevalence of gallstones in the obese and concern that rapid weight loss would increase the risk of gallbladder disease. Others recommended waiting for a lower weight and a definite need.

A decade of change in obesity surgery. National Bariatric Surgery Registry (NBSR) Contributors.

Background: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade of 1986 through 1995, as observed in the IBSR data.

Methods: All data submitted to the IBSR during the decade were transferred to the IBM mainframe computer for analysis.

Pay Status as a Predictor of Outcome in Surgical Treatment of Obesity.

BACKGROUND: Higher complication rates and lower success in surgery for severe obesity have been reported for patients with government pay status. We examined the effect of pay status upon outcome in surgical treatment of obesity. METHODS: This was an observational study from an aggregate data set of individual patient information.

The Effect of Follow-up on Reporting Success for Obesity Surgery.

BACKGROUND: Much is written about the importance of follow-up in determining the effect of surgical treatment for obesity upon weight loss. When patients are lost to follow-up, it has been suggested that these patients should be considered as failures. This study was undertaken to determine the effect of incorporating patients not followed in a definition of success for weight loss at one year.

A Study on Predicting Weight Loss Following Surgical Treatment for Obesity.

To date, longitudinal weight loss analyses (curve-fitting) have been complicated by non-linear weight patterns, incomplete follow-up, and varied follow-up times. Therefore, the cross-sectional design (one time point survey) was chosen to study predictors of weight loss at yearly postoperative time intervals (+/- 6 months). Mean values for the initial cohort of 7,540 patients were: age 37.

Calculating Follow-up Rates.

Follow-up rates are presented as a percentage but the method of calculation is seldom discussed. Determining a follow-up rate begins with identifying the numerator and denominator used in the calculation. Four methods of calculating follow-up rate after surgical treatment for weight reduction were studied.

Predictors of Two Obesity Complications: diabetes and hypertension.

Gender, age, waist-hip ratio (WHR) and body mass index (BMI) have been reported to herald two complications of obesity: diabetes or hypertension. Most literature is based on patient populations with mean BMIs ranging from 22 to 35 kg/m(2). This study population of severely obese patients selected for surgical treatment of obesity had a mean age of 37 +/- 9.

Perioperative risks and safety of surgery for severe obesity.

The National Bariatric Surgery Registry (NBSR) results reflect low perioperative risk for obesity surgery. Five deaths occurred within 40 d of operation in 5178 patients (0.1%).

Weight Loss Curve Analysis.

The purpose of this study was to develop a mathematical model to describe weight loss trend over time and to determine differences, if any, among various weight loss trends. Weight change was studied following Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). The total number of patients analyzed was 3172, 63.

Secretory reflexes in ileum and jejunum: absence of remote effects.

We have tested the hypothesis that luminal secretagogues initiate neural reflexes that alter ion transport in small intestinal segments proximal or distal to the site of the secretory stimulus. Effects of secretagogues that act by different mechanisms were studied in vitro by measuring short circuit current (ISC) of ileum or jejunum mounted in a unique flux chamber while proximal mucosa in neural continuity with the tissue was perfused with secretagogues (Na deoxycholate. Escherichia coli STa, 5-hydroxytryptamine, theophylline) or was stimulated electrically (EFS).

Ion transport in normal and inflamed human jejunum in vitro. Changes with electric field stimulation and theophylline.

We studied ion transport in human jejunal mucosa under basal conditions and when tissues were stimulated electrically (EFS) and with theophylline 5 mM (N = 12 pairs). Tissues were mounted in a flux chamber to measure unidirectional fluxes of 22Na, 36Cl, short-circuit current, Isc (mueq/cm2/hr), electrical potential difference, PD (mV), and total ionic conductance, G (mS/cm2). Six pairs of tissues that were normal or less inflamed responded to theophylline by increasing PD and Isc and by reducing JCl(ms), the mucosal to serosal flux of Cl.

Noradrenergic influence on epithelial responses of rabbit ileum to secretagogues.

Norepinephrine is one of three neurotransmitters that may act directly on enterocytes to enhance absorption; its interaction with secretagogues is of physiological importance. We have studied the influence of norepinephrine on the short-circuit current (Isc) responses to acetylcholine (ACh; 10 microM), vasoactive intestinal polypeptide (VIP; 100 pM-10 nM), peptide histidine isoleucine (PHI; 100 pM-10 nM), histamine (0.1 mM), and to electrical field stimulation (EFS) of rabbit ileum mounted in flux chambers.

The neurosecretory effect of ouabain on isolated rabbit ileal mucosa.

Ouabain, when added to fluid bathing rabbit ileal mucosa mounted in a flux chamber, transiently increases short circuit current, implying a paradoxical secretory response. To determine the cause of this change, we studied unidirectional fluxes of 36Cl and 23Na and the effects of ion substitution, of reduced Ca concentration, verapamil, tetrodotoxin and atropine. Ouabain 0.

Ion transport in human cecum, transverse colon, and sigmoid colon in vitro. Baseline and response to electrical stimulation of intrinsic nerves.

In a flux chamber study of ion transport in human colon, we compared baseline rates with those measured during electrical stimulation of intrinsic nerves. In baseline studies, sodium was absorbed throughout, but maximally in transverse colon. In cecum, sodium absorption accounted for the short circuit current and chloride was not absorbed.

Effect of neuropeptide Y on ion transport by the rabbit ileum.

Neuropeptide Y (NPY) is present in fibers extending from the submucous plexus to the epithelium of the small intestine where the liberation of NPY might affect ion transport. We sought the effects of NPY on rabbit ileal mucosa stripped of muscularis propria and mounted in a flux chamber. NPY reduced the transmural electrical potential difference and short circuit current (Isc) and increased total ionic conductance.