Laparoscopic gastric bypass: Risks vs. benefits up to two years following surgery in super-super obese patients

Gould, Jon C.; Garren, Michael; Boll, Valerie; Starling, James R.

doi:10.1016/j.surg.2006.07.002

Cited by 91 publications

(64 citation statements)

References 24 publications

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“…11 In the postoperative period, 1 patient developed transient pulmonary edema and another had acute renal failure, which required hospital readmission and resolved with hydration. There were no postoperative myocardial infarctions or anastamotic leaks.…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Ramani

McCloskey

Ramanathan

et al. 2008

Clinical Cardiology

107

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Background: Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown. Hypothesis: We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes. Methods: We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53±7 kg/m 2 ) and systolic CHF (left ventricular ejection fraction [LVEF] 22±7%, New York Heart Association [NYHA] class 2.9±0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2±3.6 kg/m 2 , LVEF 24±7%, and NYHA class 2.4±0.7) who were given diet and exercise counseling. Results: At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4±0.8 versus 2.5±2.6, p = 0.04); LVEF improved significantly in BAS patients (35±15%, p = 0.005), but not in controls (29±14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3±0.5, p = 0.02), but deteriorated in controls (3.3±0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation. Conclusions: Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status.

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Section: Resultsmentioning

confidence: 99%

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Ramani

McCloskey

Ramanathan

et al. 2008

Clinical Cardiology

107

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“…Similarly, class 5 obese patients (BMI Ͼ60 kg/m 2 ) 2 have been shown to benefit significantly from bariatric surgery with low complication rates. 204,205 Surgical intervention results in sustained weight loss, improvement in comorbidities, and increased survival. Late complications may arise from both nutritional and behavioral aspects.…”

Section: General Considerationsmentioning

confidence: 99%

Bariatric Surgery and Cardiovascular Risk Factors

Poirier¹,

Cornier²,

Mazzone³

et al. 2011

Circulation

297

134

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T he rate of obesity is rising logarithmically, especially in those with severe obesity (body mass index [BMI] Ͼ40 kg/m 2 ). Cardiologists, endocrinologists, internists, family practitioners, and most healthcare professionals are increasingly confronted with the severely obese patient and with postoperative bariatric patients because obesity is associated with significant morbidity and increased mortality. In addition, more adolescents these days are severely obese. Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in this population. The National Institutes of Health has suggested that surgical therapy be proposed to those patients with BMI Ͼ40 kg/m 2 or Ͼ35 kg/m 2 with serious obesity-related comorbidities such as systemic hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese. Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%. Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation. The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.

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“…Many authors state that the BAROS method, in particular, the Moorehead-Ardelt questionnaire, is an effective method for the evaluation of patient quality of life after weight loss [27][28][29] . This questionnaire was used in the present study and even though most patients reported an improvement in quality of life after the surgery, there was no correlation between weight loss and quality of life.…”

Section: Correlation Between Percent Loss Of Weight Excess and Pulmonmentioning

confidence: 99%

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery

Xavier¹,

Ceneviva²,

Filho³

et al. 2010

Acta Cir. Bras.

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Purpose: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. Methods: Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m 2 in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre-and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05. Results: The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre-and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF (Forced Expiratory Flow between 25 and 75% FVC) and FEV1/FVC% (Forced Expiratory Volume in the 1 st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables. Conclusions: There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation. Key words: Obesity, Morbid. Respiratory Function Tests. Quality of Life. Bariatric Surgery. RESUMOObjetivo: Investigar a evolução do peso corpóreo, da função pulmonar e da qualidade de vida de 20 pacientes obesos mórbidos seis meses após operação de Fobi-Capella. Métodos: Os pacientes foram avaliados antes e seis meses após a cirurgia e o sexo feminino predominou em 75%, com média de idade de 40,5 anos ± 10, 27, média de peso de 110,11 kg ± 21,77 e IMC de 39,93 kg/m 2 ± 7,13. Para a avaliação da função pulmonar foi realizada espirometria por meio do espirômetro Pulmonet Godart NV Bilt Vetr Holland, e para a qualidade de vida foi aplicado o questionário de Moorehead-Ardelt. As comparações entre os valores espirométricos do pré e do pós-operatório foram realizadas pelo teste t de Student para amostras pareadas, e para a correlação entre a perda de peso e função pulmonar utilizou-se análise de regressão linear simples, adotando-se p < 0,05 para todos os resultados. Resultados: As variáveis espirométricas Freqüência Respiratória (FR), Volume de Reserva Expiratório (VRE) e Capacidade Residual Funcional (CRF) apresentaram, aos seis meses após a operação, diferença estatisticamente significativa com os valores pré-operatórios, porém, não houve diferença ...

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Laparoscopic gastric bypass: Risks vs. benefits up to two years following surgery in super-super obese patients

Cited by 91 publications

References 24 publications

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Bariatric Surgery and Cardiovascular Risk Factors

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery

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