Using this systematic approach, it has been possible to cover >99% of all bariatric surgery, cross-matching our data with nation-wide registries for in-hospital care, cause of death, and permitting regular nation-wide audit. Several scientific studies have used, or are using, what seems to be the most comprehensive database in obesity surgery.
Omeprazole, 20 mg once daily, provides effective prophylactic therapy in patients at risk of developing NSAID-associated peptic ulcers or dyspeptic symptoms.
The study discloses a strong and dose-dependent association between body mass and reflux oesophagitis in women as opposed to no association among men. This association might be caused by increased oestrogen activity in overweight and obese females.
We followed for 25 to 33 years 6459 patients who had undergone partial gastrectomy for benign ulcer disease to determine the incidence of stomach cancer. The overall risk was no different from that among sex- and age-matched controls from the Swedish Cancer Registry (standardized incidence ratio = 0.96; 95 percent confidence limits, 0.78 and 1.16). However, when the patients were classified according to the duration of follow-up after operation, sex, surgical procedure, diagnosis at the time of operation, and age at operation, differences in risk were observed between the subgroups. After adjustment for potential confounding variables, the average adjusted risk increased 28 percent (adjusted standardized incidence ratio = 1.28; 95 percent confidence limits, 1.11 and 1.49) for each successive five-year interval after operation. The adjusted risk was greater among women than men (adjusted standardized incidence ratio = 1.96; 95 percent confidence limits, 1.18 and 3.24). Patients who had undergone a Billroth I anastomosis had a lower crude risk, both overall (standardized incidence ratio = 0.40; 95 percent confidence limits, 0.20 and 0.71) and after we controlled for other confounding variables (adjusted standardized incidence ratio = 0.27; 95 percent confidence limits, 0.12 and 0.62), than did those who had undergone a Billroth II procedure. The adjusted risk of stomach cancer was greater among patients operated on for gastric ulcer than among those operated on for duodenal ulcer (adjusted standardized incidence ratio = 2.21; 95 percent confidence limits, 1.45 and 3.35). Risk decreased with increased age at operation. Between successive strata of age at operation (less than 39, 40 to 49, 50 to 59, and greater than or equal to 60 years of age), the adjusted risk decreased on the average by about half (adjusted standardized incidence ratio = 0.52; 95 percent confidence limits, 0.41 and 0.66).
Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
Objective: To evaluate effect on comorbid disease and weight loss five years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. Summary Background Data:The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. Results: BMI decreased from 42.8 ±5.5 to 31.2 ±5.5 kg/m 2 at five years, corresponding to 27.7%-reduction in total body weight. Prevalence of T2DM was reduced (15.5% to 5.9%), hypertension (29.7% to 19.5%), dyslipidemia (14.0% to 6.8%) and sleep apnea (9.6% to 2.6%). Greater weight loss was a positive, while increasing age or BMI at baseline, were negative prognostic factors for remission. The use of anti-depressants increased (24.1% to 27.5%). Laboratory status was improved, e.g. fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8 to 37.7%, respectively. Conclusions:In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a five-year period. The increased use of anti-depressants warrants further investigation.
The risk of developing a second primary cancer was studied among 34,506 gastric cancer patients identified through the Swedish Cancer Registry. A second cancer was reported in 962 patients compared to an expected number of 826 (relative risk = 1.16, 95% confidence limits = 1.09-1.24). The slightly but significantly elevated risk was largely confined to the first year after the gastric cancer diagnosis, and to patients under 70 years old at the time of diagnosis. The risk was significantly increased for cancer in the small intestine, colon, rectum, kidney, breast and prostate. A closer look at the data, however, revealed that a substantial proportion of the second cancers were diagnosed within one month after the gastric cancer diagnosis, or at autopsy. We recalculated the relative risk estimates under the assumption that only 75% of the cancers incidentally detected in connection with diagnosis/treatment of the gastric cancer would have become clinically manifest during the relatively short observation time. and that 20% of the cancers revealed at autopsy in the gastric cancer patients would have been detected if the death and autopsy rates in this group had been equal to those in the general population (matched for age and gender). Under those assumptions the risk of having a second primary cancer among gastric cancer patients was close to what would be expected. The increased risk reported in some previous studies could be the result of closer patient surveillance.
Partial gastrectomy for benign ulcer disease may influence future risk of death, eg, through changes in life-style or metabolism. To reveal such possible long-term effects, we analyzed a population-based cohort of 6459 patients operated on from 1950 through 1958 and followed through 1985. We found a lower overall mortality than in the general Swedish population (standardized mortality ratio = 0.94; 95% confidence interval 0.91-0.97). Mortality was decreased among those with duodenal ulcers, Billroth II operations, and older age at operation but increased as time passed after operation. Mortality was significantly (P < 0.05) increased from tuberculosis, alcoholism, emphysema, stomach ulcer, intestinal obstruction, gallbladder or biliary disease, suicide, and accidental falls but decreased from ischemic heart disease and cerebrovascular disease. Preoperative selection of healthy patients and the probable increased prevalence of risk factors for ulcer disease (smoking, alcoholism, and lower socioeconomic status) in this cohort explain most of these findings. Apart from intestinal obstruction, gallbladder or biliary tract diseases, and tuberculosis, the surgical procedure did not appear to increase mortality beyond one year after operation.
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