Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Factors Related with Adiponectinemia in Obese and Normal-Weight Women and with Its Variation in Weight Loss Programs Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Adolescent obesity in Syria: prevalence and associated factors. Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Laparoscopic Bariatric Surgery A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery Use of Enoxaparin in Obese Adolescents During Bariatric Surgery—a Pilot Study Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Decreased Levels of Circulating Cancer-Associated Protein Biomarkers Following Bariatric Surgery An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery The Effect of Bariatric Surgery on Patient HRQOL and Sexual Health During a 1-Year Postoperative Period The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity Effects of bariatric surgery on mortality in Swedish obese subjects. Evaluation of Gastric Bypass Patients 1 Year After Surgery: Changes in Quality of Life and Obesity-Related Conditions The Effect of Obesity on Anti-Xa Concentrations in Bariatric Patients Road Running After Gastric Bypass for Morbid Obesity: Rationale and Results of a New Protocol Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study
Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients Objective : To assess different factors influencing adiponectinemia in obese and normal-weight women ; to identify factors associated with the variation ( Δ ) in adiponectinemia in obese women following a 6-month weight loss program  , according to surgical/non-surgical interventions . Methods : We studied 100 normal-weight women and 112 obese premenopausal women ; none of them was on any medical treatment . Women were characterized for anthropometrics , daily macronutrient intake , smoking status , contraceptives use , adiponectin as well as IL-6 and TNF-α serum concentrations . Results : Adiponectinemia was lower in obese women ( p < 0.001 ) , revealing an inverse association with waist-to-hip ratio ( p < 0.001 ; r = -0.335 ) . Normal-weight women presented lower adiponectinemia among smokers ( p = 0.041 ) ; body fat , waist-to-hip ratio , TNF-α levels , carbohydrate intake , and smoking all influence adiponectinemia ( r2 = 0.436 ) . After weight loss interventions , a significant modification in macronutrient intake occurs followed by anthropometrics decrease ( chiefly after bariatric procedures ) and adiponectinemia increase ( similar after surgical and non-surgical interventions ) . After bariatric intervention , Δ adiponectinemia was inversely correlated to Δ waist circumference and Δ carbohydrate intake ( r2 = 0.706 ) . Conclusion : Anthropometrics , diet , smoking , and TNF-α levels all influence adiponectinemia in normal-weight women , although explaining less than 50 % of it . In obese women , anthropometrics modestly explain adiponectinemia . Opposite to non-surgical interventions , after bariatric  surgery adiponectinemia increase is largely explained by diet composition and anthropometric changes Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Abstract Background Data on the prevalence of overweight and obesity in Eastern Mediterranean countries remain scarce , particularly for children and adolescents . The objective of this study is to estimate the prevalence of obesity and examine associated factors and covariates amongst school adolescents in Syria . Methods A cross-sectional survey of a representative sample of 776 adolescents ( 386 males and 390 females ) , aged 15 - 18 years , was conducted in six r and omly chosen secondary schools in Damascus , the capital city of Syria .  Anthropometric measurements and dietary assessment data  were collected using st and ard methods and techniques . Overweight and obesity were defined according to World Health Organization 2007 child growth st and ards . Results The prevalence rates of overweight and obesity were estimated at 18.9 and 8.6 % , respectively . Carbohydrate and saturated fatty acid intakes were significantly higher amongst overweight and obese ( 250.66 and 32.82 g/day , respectively ) as compared with normal weight adolescents ( 218.12 and 26.10 g/day , respectively ) . Regression analysis showed that the likelihood of obesity was significantly greater amongst adolescent boys than girls ( OR = 2.30 , P < 0.05 ) and amongst subjects reporting family history of obesity ( OR = 2.98 , P < 0.05 ) . The odds of obesity increased consistently with increasing educational attainment of both parents and was higher ( OR = 1.63 ) amongst adolescents reporting lower crowding index than their counterparts . Conclusion Our findings of a positive association between obesity and socio-economic status measured by parental education and crowding index call for intervention strategies for the promotion of healthy dietary practice s not only amongst school adolescents but also parents , targeting families as the unit of intervention . Further studies are needed to examine nutritional habits and food choices amongst families of different socio-economic strata BACKGROUND : Atelectasis occurs regularly after induction of general anesthesia , persists postoperatively , and may contribute to significant postoperative morbidity and additional health care costs . Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis . It has been shown that during general anesthesia , obese patients have a greater risk of atelectasis than nonobese patients . Preventing atelectasis is important for all patients but is especially important when caring for obese patients . METHODS : We r and omly allocated 66 adult obese patients with a body mass index between 30 and 50 kg/m2 scheduled to undergo laparoscopic bariatric surgery  into 3 groups . According to the recruitment maneuver used , the zero end-expiratory pressure ( ZEEP ) group ( n = 22 ) received the vital capacity maneuver ( VCM ) maintained for 7–8 s applied immediately after intubation plus ZEEP ; the positive end-expiratory pressure ( PEEP ) 5 group ( n = 22 ) received the VCM maintained for 7–8 s applied immediately after intubation plus 5 cm H2O of PEEP ; and the PEEP 10 group ( n = 22 ) received the VCM maintained for 7–8 s applied immediately after intubation plus 10 cm H2O of PEEP . All other variables ( e.g. , anesthetic and surgical techniques ) were the same for all patients . Heart rate , noninvasive mean arterial blood pressure , arterial oxygen saturation , and alveolar-arterial Pao2 gradient ( A-a Pao2 ) were measured intraoperatively and postoperatively in the postanesthesia care unit ( PACU ) . Length of stay in the PACU and the use of a nonrebreathing O2 mask ( 100 % Fio2 ) or reintubation were also recorded . A computed tomographic scan of the chest was performed preoperatively and postoperatively after discharge from the PACU to evaluate lung atelectasis . RESULTS : Patients in the PEEP 10 group had better oxygenation both intraoperatively and postoperatively in the PACU , lower atelectasis score on chest computed tomographic scan , and less postoperative pulmonary complications than the ZEEP and PEEP 5 groups . There was no evidence of barotrauma in any patient in the 3 study groups . CONCLUSIONS : Intraoperative alveolar recruitment with a VCM followed by PEEP 10 cm H2O is effective at preventing lung atelectasis and is associated with better oxygenation , shorter PACU stay , and fewer pulmonary complications in the postoperative period in obese patients undergoing laparoscopic bariatric surgery Background Bariatric surgery is often associated with reduced food tolerance and sometimes frequent vomiting , which influence quality of life , but are not included in the overall evaluation of these procedures , notably the BAROS . Our aim was to develop a simple question naire to evaluate food tolerance during follow-up visits . Methods A one-page question naire including questions about overall satisfaction regarding quality of alimentation , timing of eating over the day , tolerance to several types of food , and frequency of vomiting/ regurgitation was developed . A composite score was derived from this question naire , giving a score of 1 to 27.Validation was performed with a group of nonobese adults and a group of morbidly obese nonoperated patients . Patients were administered the question naire at follow-up visits since January 1999 . Data were collected prospect ively . Results It takes 1–2 minutes to fill out the question naire . Food tolerance is worse in the morbidly obese population compared with non-obese adults ( 24.2 vs 25.2 , P=0.004 ) . Following Roux-en-Y gastric bypass , food tolerance is reduced after 3 months ( 21.2 ) , but becomes comparable to that of the normal population and remains so at 1 year postoperatively . Following gastric b and ing , food tolerance is already significantly reduced after 3 months ( 22.3 ) , and worsens continuously over time ( 19.03 after 7 years ) . In the gastric b and ing population , the decision to adjust the b and is based at least partially on food tolerance , and the question naire proved helpful in that respect . Conclusion Our new question naire proved very easy to use , and helpful in day-to-day practice , especially after gastric b and ing . It was also helpful in comparing food tolerance over time after surgery , and in comparing food tolerance between procedures . Evaluation of food tolerance should be part of the overall evaluation of the results after bariatric surgery Background Obese patients have a higher risk of venous thromboembolism when immobilized due to surgery . The objective of this study was to assess anti-factor Xa activity in adolescent bariatric surgical patients receiving prophylactic enoxaparin .  Methods Four morbidly obese adolescents undergoing laparoscopic sleeve gastrectomy were enrolled . Enoxaparin was administered ( 40 mg subcutaneous ( SC ) if BMI ≤50 kg/m2 or 60 mg SC if BMI > 50 kg/m2 ) for prevention of venous thromboembolism every 12 h starting after induction of anesthesia until discharge . Plasma anti-factor Xa activity was assessed over 12 h after the first dose and used as a surrogate marker for enoxaparin levels . Non-compartmental analysis of anti-factor Xa activity levels was performed and compared with previously published studies . Results Patients recruited were 16 to 18 years of age with a mean BMI of 52.6 ± 5.8 kg/m2 ( > 99th BMI percentile ) . Peak anti-factor Xa activity ranged from 0.20 to 0.23 IU/mL in our study population , compared to 0.38 to 0.53 IU/mL in the cited lean comparator groups . Conclusions Our current dosing practice of 40 mg SC for individuals with a BMI ≤50 kg/m2 and 60 mg for individuals with a BMI ≥50 kg/m2 result ed in anti-factor Xa activity that was sufficient for adequate thromboprophylaxis in adolescent bariatric surgical patients . Our data also demonstrates lower drug exposures in the obese when compared to lean patients . Therefore , r and omized controlled efficacy and safety studies are urgently needed to guide the use of low-molecular-weight heparins in the pediatric and adolescent obese population Background : Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery . The aim of this study was to evaluate the effect of a vital capacity manoeuvre ( VCM ) , followed by ventilation with positive end‐expiratory pressure ( PEEP ) , on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery . Methods : Fifty‐two morbidly obese patients ( body mass index > 40 kg m−2 ) undergoing open bariatric surgery were enrolled in this prospect i ve and r and omized study . Anaesthesia and surgical techniques were st and ardized . Patients were ventilated with a tidal volume of 10 mL kg−1 of ideal body weight , a mixture of oxygen and nitrous oxide ( FiO2 = 40 % ) and respiratory rate was adjusted to maintain end‐tidal carbon dioxide at a level of 30–35 mmHg . After abdominal opening , patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O . This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups . Haemodynamics , ventilatory and arterial oxygenation parameters were measured at the following times : T0 = before application of VCM and /or PEEP , T1 = 5 min after VCM and /or PEEP and T2 = before abdominal closure . Results : Patients in the two groups were comparable regarding patient characteristics , surgical , haemodynamic and ventilatory parameters . In Group 1 , arterial oxygen partial pressure ( PaO2 ) and arterial haemoglobin oxygen saturation ( SaO2 ) were significantly increased and alveolar‐arterial oxygen pressure gradient ( A‐aDO2 ) decreased at T2 when compared with T0 and T1 . In Group 2 , PaO2 and SaO2 were significantly increased and A‐aDO2 decreased at T1 and T2 when compared with T0 . Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1 . Conclusion : The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity Background Epidemiological studies have identified obesity as a major risk factor for cancer in humans , and trials have demonstrated a significant reduction in the incidence of cancer after bariatric surgery . The rapidity of weight loss after bariatric surgery provides an opportunity to identify the molecular changes associated with effective obesity treatment . Indirectly , this may provide some insights into the mechanisms that drive the association between obesity and cancer . We sought to measure circulating cancer-associated proteins before and after laparoscopic sleeve gastrectomy ( LSG ) . Methods We prospect ively enrolled 15 patients undergoing LSG .  Thirty-four plasma protein biomarkers thought to be associated with cancer processes were analyzed at baseline and following successful weight loss at 12 weeks using a multiplex bead-based assay .  Results Mean excess body weight loss was 44 % at 12-week follow-up . After LSG , a significant reduction in circulating plasma levels was observed for half ( 17/34 ) of the proteins assessed : VEGF-A , VEGF-C , VEGF-D , endoglin , PLGF , sFASL , IGFBP-1 , IL-18 , prolactin , EGF , TGFα , sCD40L , IL-18 , TNFα , IL-6 , HB-EGF , and PAI-1 . Nonsignificant decreases were found for the remaining proteins . Conclusions Circulating cancer-related biomarker levels were reduced by surgical weight loss , and this benefit was achieved as early as 3 months after operation . The observed reduction in cancer biomarkers may be related to the reported decrease in cancer incidence following bariatric surgery Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Background Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery . For bariatric surgery , increased vomiting/retching is detrimental to surgical anastomosis . The present study evaluated the efficacy of aprepitant ( neurokinin-1 inhibitor ) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery . Methods After institutional review board approval , 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial . On r and om division , the patients received a tablet of aprepitant ( 80 mg ) in group A , or a similar-appearing placebo in group P , an hour prior to surgery . All patients received intravenous ondansetron ( 4 mg ) intraoperatively . Postoperatively , the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min , 1 , 2 , 6 , 24 , 48 , and 72 h. Results Both groups were evenly distributed for age , body mass index , type , and length of surgery . Cumulative incidence of vomiting at 72 h was significantly lower in group A ( 3 % ) compared to group P ( 15 % ; p = 0.021 ) . Odds ratio for vomiting in group P compared to group A was 5.47 times . On Kaplan – Meier plot , time to first vomiting was also significantly delayed in group A ( p = 0.019 ) . A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P ( 42.18 vs. 36.67 % ) . On the other h and , nausea scores were unaffected by aprepitant , and no significant difference between groups was found at any of the measured time points . Conclusions In morbidly obese patients undergoing laparoscopic bariatric surgery , addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting Background Negative consequences of the obesity epidemic include decreased physical , psychological , and sexual health .  Bariatric surgery is a well-tolerated and effective treatment for morbid obesity . This study aim ed to determine the effect of bariatric surgery on health-related quality of life ( HRQOL ) and sexual functioning and to identify potential predictors of this effect . Methods Eighty morbidly obese patients ( 50 women ) completed the study .  HRQOL was measured using the Short Form 36 question naire ( SF-36 ) . Sexual functioning was assessed using the Female Sexual Functioning Index ( FSFI ) and the International Index of Erectile Function ( IIEF ) . All participants were evaluated four times as follows : presurgery ( T1 ) , 1 month ( T2 ) , 6 months ( T3 ) , and 1 year ( T4 ) after surgery . Results Body mass index ( BMI ) significantly decreased over time ( p < 0.001 ) . Apart from male orgasm , all sexual functioning components as well as all SF-36 sub-scales improved between T1 and T4 . The maximum improvement was observed between T2 and T3 . Baseline HRQOL scores correlated with postoperative improvement in all HRQOL components . BMI improvement was correlated with improvement in role physical , bodily pain , and mental health scores . Baseline total sexual satisfaction score independently predicted total satisfaction improvement in both genders . Conclusions The present findings indicate that bariatric surgery represents an effective obesity treatment , leading to significant BMI reduction and improvement in HRQOL and sexual functioning , especially in the first 6 months postoperatively CONTEXT The polycystic ovary syndrome ( PCOS ) is frequently associated with obesity . However , there are very few data about PCOS in morbid obesity , especially with regard to its evolution after bariatric surgery . OBJECTIVE The objective of this study was to evaluate the response of PCOS to the sustained and marked weight loss achieved by  bariatric surgery in morbidly obese women . DESIGN This was a longitudinal prospect i ve nonr and omized evaluation . SETTING S The study was performed at an academic hospital . PATIENTS Thirty-six consecutive premenopausal women su bmi tted to bariatric surgery were screened for PCOS , which was present in 17 . INTERVENTIONS Bariatric surgery was performed . MAIN OUTCOME MEASURES Hyper and rogenism , menstrual function , and insulin resistance were estimated before and at least 6 months after bariatric surgery in 12 patients with PCOS . RESULTS Weight loss ( 41 + /- 9 kg after 12 + /- 5 months ) was paralleled by decreases in the hirsutism score ( from 9.5 + /- 6.8 to 4.9 + /- 4.2 ; P = 0.001 ) , total ( 69 + /- 32 to 42 + /- 19 ng/dl ; P < 0.02 ) and free testosterone ( from 1.6 + /- 0.7 to 0.6 + /- 0.3 ng/dl ; P < 0.005 ) , and rostenedione ( from 4.1 + /- 1.5 to 3.0 + /- 0.9 ng/ml ; P < 0.02 ) , and dehydroepi and rosterone sulfate ( from 2000 + /- 1125 to 1353 + /- 759 ng/ml ; P < 0.005 ) ; amelioration of insulin resistance estimated by homeostasis model assessment ( from 6.0 + /- 3.0 to 1.6 + /- 1.0 ; P < 0.001 ) ; and restoration of regular menstrual cycles and /or ovulation in all patients . CONCLUSIONS The PCOS is a frequent finding in women with morbid obesity and may resolve after weight loss induced by bariatric surgery Importance Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes , and medical management , including lifestyle changes , may not be successful at lowering risk . Objective To investigate the relationship between bariatric surgery and incident macrovascular ( coronary artery disease and cerebrovascular diseases ) events in patients with severe obesity and type 2 diabetes . Design , Setting , and Participants In this retrospective , matched cohort study , patients with severe obesity ( body mass index ≥35 ) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States ( n = 5301 ) were matched to 14 934 control patients on site , age , sex , body mass index , hemoglobin A1c , insulin use , observed diabetes duration , and prior health care utilization , with follow-up through September 2015 . Exposures Bariatric procedures ( 76 % Roux-en-Y gastric bypass , 17 % sleeve gastrectomy , and 7 % adjustable gastric b and ing ) were compared with usual care for diabetes . Main Outcomes and Measures Multivariable-adjusted Cox regression analysis investigated time to incident macrovascular disease ( defined as first occurrence of coronary artery disease [ acute myocardial infa rct ion , unstable angina , percutaneous coronary intervention , or coronary artery bypass grafting ] or cerebrovascular events [ ischemic stroke , hemorrhagic stroke , carotid stenting , or carotid endarterectomy ] ) . Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately . Results Among a combined 20 235 surgical and nonsurgical patients , the mean ( SD ) age was 50 ( 10 ) years ; 76 % of the surgical and 75 % of the nonsurgical patients were female ; and the baseline mean ( SD ) body mass index was 44.7 ( 6.9 ) and 43.8 ( 6.7 ) in the surgical and nonsurgical groups , respectively . At the end of the study period , there were 106 macrovascular events in surgical patients ( including 37 cerebrovascular and 78 coronary artery events over a median of 4.7 years ; interquartile range , 3.2 - 6.2 years ) and 596 events in the matched control patients ( including 227 cerebrovascular and 398 coronary artery events over a median of 4.6 years ; interquartile range , 3.1 - 6.1 years ) . Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years ( 2.1 % in the surgical group vs 4.3 % in the nonsurgical group ; hazard ratio , 0.60 [ 95 % CI , 0.42 - 0.86 ] ) , as well as a lower incidence of coronary artery disease ( 1.6 % in the surgical group vs 2.8 % in the nonsurgical group ; hazard ratio , 0.64 [ 95 % CI , 0.42 - 0.99 ] ) . The incidence of cerebrovascular disease was not significantly different between groups at 5 years ( 0.7 % in the surgical group vs 1.7 % in the nonsurgical group ; hazard ratio , 0.69 [ 95 % CI , 0.38 - 1.25 ] ) . Conclusions and Relevance In this observational study of patients with type 2 diabetes and severe obesity who underwent surgery , compared with those who did not undergo surgery  , bariatric surgery was associated with a lower risk of macrovascular outcomes . The findings require confirmation in r and omized clinical trials . Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Background Obesity has recently been cited as the number one killer in the USA . This problem is both a national and regional epidemic . The health care costs of obesity and obesity-related illnesses are ever increasing , and gastric bypass surgery is becoming a popular treatment strategy . Recently , reports describe not only surgical outcomes , but also quality of life outcomes . The bigger issue of obesity-related illness resolution is still evolving . Our institution has performed well over 500 gastric bypasses since 2002 . We evaluated over 100 patients prior to and 1 year after gastric bypass surgery .  Methods A prospect i ve study was design ed in order to systematic ally examine quality of life in  gastric bypass patients and couple the results with both objective and subjective assessment of bariatric surgery outcomes . One hundred nineteen patients undergoing gastric bypass at our institution from January 2005 to December of 2005 were enrolled in the study . In addition to routine preprocedural and postprocedural follow-up , completion of  quality of life  forms and anthropometric measurements were performed . Using these data , we then correlated the change in quality of life scores with social factors , weight loss success , and status of obesity-related conditions . We also examined the impact of alcohol intake and other demographic factors on both quality of life and obesity related conditions . Results A total of 119 patients were enrolled in the study during the calendar year 2005 . Follow-up at approximately 1 year ( average 12.86 months ) postsurgery was obtained in 75 patients . A significant reduction in weight ( 144.4 ± 34.4 vs. 91.5 ± 28.8 ; p < 0.0001 ) , body mass index ( 52.4 ± 12.2 vs. 32.3 ± 8.6 ; p < 0.0001 ) , mean systolic blood pressure ( 140.4 ± 14.7 vs. 130.0 ± 21.7 ; p < 0.001 ) , and lipids ( 194.3 ± 33.8 vs. 165.7 ± 32.1 ; p < 0.0001 ) was noted . Quality of life scores 1 year after gastric bypass surgery were also significantly improved ( 35.9 ± 19.5 vs. 82.2 ± 23.5 ; p < 0.0001 ) . There was also a significant reduction in the reported usage of medications for obesity related conditions . Various measures of success ( change in BMI , change in quality of life scores , and follow up health ranking ) were compared across demographic and social factors and no significant associations were identified . Conclusions Gastric bypass is associated with a reduction in weight , BMI , mean systolic blood pressure , cholesterol , and the usage of medications for obesity-related conditions . A significant improvement in quality of life was also noted 1 year after surgery Background Morbidly obese patients are at increased risk to develop venous thromboembolism ( VTE ) , especially after bariatric surgery . Adequate postoperative thrombosis prophylaxis is of utmost importance . It is assumed that morbidly obese patients need higher doses of low molecular weight heparin ( LMWH ) compared to normal-weight patients ; however , current guidelines based on relative efficacy in obese population s are lacking . Objectives First , we will evaluate the relationship between body weight descriptors and anti-Xa activity prospect ively . Second , we will determine the dose-linearity of LMWH in morbidly obese patients . Setting This study was performed in a general hospital specialized in bariatric surgery . Methods Patients were scheduled for a Roux-en-Y gastric bypass with a total bodyweight ( TBW ) of ≥ 140 kg . Patients ( n = 50 , 64 % female ) received a daily postoperative dose of 5700 IU of nadroparin for 4 weeks  . Anti-Xa activity was determined 4 h after the last nadroparin administration . To determine the dose linearity , anti-Xa was determined following a preoperative dose of 2850 IU nadroparin in another 50 patients ( 52 % ) . Results TBW of the complete group was 148.5 ± 12.6 kg . Mean anti-Xa activity following 5700 IU nadroparin was 0.19 ± 0.07 IU/mL. Of all patients , 32 % had anti-Xa levels below the prophylactic range . Anti-Xa activity inversely correlated with TBW ( correlation coefficient − 0.410 ) and lean body weight ( LBW ; correlation coefficient − 0.447 ) ; 67 % of patients with a LBW ≥ 80 kg had insufficient anti-Xa activity concentrations . No VTE events occurred . Conclusions In morbidly obese patients , a postoperative dose of 5700 IU of nadroparin result ed in subprophylactic exposure in a significant proportion of patients . Especially in patients with LBW ≥ 80 kg , a higher dose may potentially be required to reach adequate prophylactic anti-Xa levels Background In recent years , the p and emic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery , confining physical activity to a success parameter of surgery rather than a primary prevention measure . The aim of this study is to evaluate the role for aerobic physical activity ( road running ) in strengthening the metabolic and psychosocial effects of bariatric surgery . Methods Ten patients who underwent gastric bypass for morbid obesity were su bmi tted to an intensive program of road running training , aim ed at completing a 10.5-km competition in September 2013 . Inclusion criteria included age ( < 50 ) , BMI ( < 35 ) , suitability for sport activity , and good compliance . A cohort of 10 patients excluded for logistical issues were enrolled as a  control group . During the training period , patients were su bmi tted to biometrical , sport performance , cardiopulmonary , metabolic , and psychiatric evaluations . Results Protocol adherence was 70 % ; no physical injury was registered among participants . More than weight loss ( BMI 29.3 to 27.1 ) , the runners experienced a redistribution of body mass with significant differences in fat percentage and waist/hip ratio . Participants had a significant running performance improvement and , differently from the controls , a significant amelioration of echocardiographic and cardiopulmonary parameters , predicting a reduction in cardiovascular risk . Psychiatric evaluation underlined a tendency to a reduction in anxiety , depression , and general psychopathology symptoms . Conclusions Road running seems to have an important supporting role in boosting bariatric surgery results . The utilization of monitored and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and patient compliance Objective : The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery . Methods : Prospect i ve r and omized controlled trial . Obese patients ( body mass index > 50 Kg/m2 ) undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent . Patients were r and omized using a computer generated r and omization table to receive either opioid or non-opioid based anesthesia . The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol . Primary outcomes were hemodynamics in the form of “ heart rate , systolic , diastolic , and mean arterial blood pressure ” on induction and ½ hourly thereafter . Pain monitoring through visual analog scale ( VAS ) 30 min after recovery , hourly for 2 h and every 4 h for 24 h was also recorded . Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction . Results : There was no difference in background characteristics in both groups . There were no statistically significant differences in different outcomes as heart rate , mean blood pressure , O2 saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment . Conclusion : Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one . There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia
Furthermore , except for certain cardiovascular indicators , bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters ( P < 0.05 ) .
Bariatric surgery is a better therapeutic option for weight loss , irrespective of follow-up duration , surgical techniques and obesity levels
BACKGROUND Bariatric surgery has emerged as a competitive strategy for obese patients .
However , its comparative efficacy against non-surgical treatments remains ill-defined , especially among nonseverely obese crowds .