Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality

Reges, Orna; Greenland, Philip; Dicker, Dror; Leibowitz, Morton; Hoshen, Moshe; Gofer, Ilan; Rasmussen‐Torvik, Laura J.; Balicer, Ran D.

doi:10.1001/jama.2017.20513

Cited by 173 publications

(123 citation statements)

References 11 publications

(25 reference statements)

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“…Bariatric surgery was associated with significantly lower mortality rates from all causes, in a medium follow-up of 4.5years. 1 All of the patients in our series had a history of failed attempts with conservative treatments prior to surgery.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Concerns during Initiation of Sleeve Gastrectomy in a Laparoscopic Bariatric Program: A Single Surgeon’s Initial Experience and Review of Latest Literature

Hirides¹,

Hirides²

2018

AOWMC

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Introduction: Among the existing weight-loss procedures, laparoscopic sleeve gastrectomy has gained increasing popularity in the past decade, due to its remarkable results concerning EWL and resolution of comorbidities. However, most of major concerns for a team initiating with sleeve gastrectomy, still remain as subjects of major controversy among authors. Aim: to present a single surgeon's technique and initial results with laparoscopic sleeve gastrectomy and review the latest literature for main concerns of a novice team. Material: Six patients aged 24-49years, underwent full preoperative workup, including history, physical examination, evaluation from cardiologist, anesthesiologist, as well as clinical dietician and pneumologist. A laparoscopic sleeve gastrectomy was offered as the most suitable bariatric procedure for 5 of the patients. One of the patients underwent a robotic-assisted technique. Results: All 6 patients followed an uncomplicated course. All patients were assessed for leaks on postoperative day 2 by gastrographin swallow. One patient presented with high fever on postoperative day 4 and was readmitted. No leaks were noted in any of the patients. Conclusion: Reinforcing the staple line during sleeve gastrectomy by suturing and glue is the routine followed by the authors. Robotics seem to facilitate sleeve gastrectomy, especially during challenging mobilization of the fundus near the spleen as well as during intracorporeal suturing. Advances in Obesity Weight Management & Control Research Article Open Access Concerns during initiation of sleeve gastrectomy in a laparoscopic bariatric program: a single surgeon's initial experience and review of latest literature 18 Copyright: ©2018 Hirides et al.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Concerns during Initiation of Sleeve Gastrectomy in a Laparoscopic Bariatric Program: A Single Surgeon’s Initial Experience and Review of Latest Literature

Hirides¹,

Hirides²

2018

AOWMC

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“…There were 105 deaths (1.3%) in the surgical cohort during a median follow‐up of 4.3 years and 583 deaths (2.3%) among nonsurgical patients during a median follow‐up of 4.0 years. The adjusted hazard ratio for mortality among nonsurgical vs surgical patients was 2.02 (95% CI, 1.6‐2.5) …”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery is associated with a lower rate of death after myocardial infarction and stroke: A nationwide study

Aminian

Aleassa

Bhatt

et al. 2019

Diabetes Obesity Metabolism

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Aim: To assess the potential protective effect of bariatric surgery on mortality after myocardial infarction (MI) or cerebrovascular accident (CVA).patients with a principal discharge diagnosis of acute MI and 2168 patients with ischaemic CVA who also had history of prior bariatric surgery were identified. Utilizing propensity scores, these patients were matched 1:5 with patients who had similar principal diagnoses but no history of bariatric surgery (controls). Control group-1 included participants with obesity (BMI ≥ 35 kg/m 2 ) only and participants in control group-2 were matched according to post-surgery BMI with the bariatric surgery group. The primary and secondary endpoints were in-hospital all-cause mortality and length of hospital stay, respectively. Outcomes after MI and CVA were separately compared among groups in multivariate regression models.Results: A total of 48 300 (weighted) participants were included in the analysis. The distribution of covariates was well balanced after propensity matching. Mortality rates after MI were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.85% vs 3.03%; odds ratio (OR), 0.61; 95% confidence interval (CI), 0.44-0.86; P = 0.004) and with control group-2 (2.00% vs 3.26%; OR, 0.62; 95% CI, 0.44-0.88; P = 0.008). Similarly, in-hospital mortality rates after CVA were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.43% vs 2.74%; OR, 0.54; 95% CI, 0.37-0.79; P = 0.001) andwith control group-2 (1.54% vs 2.59%; OR, 0.61; 95% CI, 0.41-0.91; P = 0.015). Furthermore, length of stay was significantly shorter in the bariatric surgery group for all comparisons (P < 0.001).Conclusion: Prior bariatric surgery is associated with significant protective effect on survival after MI and CVA. K E Y W O R D Sbariatric surgery, cerebrovascular accident, metabolic surgery, myocardial infarction, obesity, stroke

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“…Nonetheless, it is very important to put these detrimental outcomes of metabolic surgery in perspective. The success rate and health benefits of metabolic surgery are also much stronger and longer lasting than those of medical therapy (28,29,30,31,167,168). The reduced overall long-term mortality, which has been repeatedly shown after metabolic surgery includes mortality from suicide (27,28,29,114), clearly outweighs the potential risks of metabolic operations.…”

Section: Non-surgical Complications and Increased Risk For Self-harmmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass

Billeter

Herrera

Scheurlen

et al. 2018

European Journal of Endocrinology

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Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.

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Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality

Cited by 173 publications

References 11 publications

Concerns during Initiation of Sleeve Gastrectomy in a Laparoscopic Bariatric Program: A Single Surgeon’s Initial Experience and Review of Latest Literature

Concerns during Initiation of Sleeve Gastrectomy in a Laparoscopic Bariatric Program: A Single Surgeon’s Initial Experience and Review of Latest Literature

Bariatric surgery is associated with a lower rate of death after myocardial infarction and stroke: A nationwide study

MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass

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