Improvement in health-related quality of life following Roux-en-Y gastric bypass. Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. Bile acids and gut peptide secretion after bariatric surgery: a 1-year prospective randomized pilot trial. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH) Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass Bariatric surgery versus intensive medical therapy in obese patients with diabetes. A mindfulness-based intervention to control weight after bariatric surgery: Preliminary results from a randomized controlled pilot trial. Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. 15-year follow-up of vertical banded gastroplasty: comparison with other restrictive procedures Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Effects of Bariatric Surgery in Obese Patients With Hypertension Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. Perioperative safety in the longitudinal assessment of bariatric surgery.
INTRODUCTION This study explored whether health-related quality of life ( HRQOL ) changes following  Roux-en-Y gastric bypass surgery  were associated with identifiable socio-demographic or clinical characteristics , and it examined the impact on health outcomes of changes in the Danish criteria for bariatric surgery . MATERIAL AND METHODS Participants ( n = 55 ) completed the Short Form Health Survey v2 ( SF-36 ) before and 22 ± 4.2 months after surgery . Information on socio-demographics , body mass index ( BMI ) , co-morbidity and satisfaction with surgery were collected through patient question naires and hospital records . RESULTS There was overall improvement on all SF-36 subscales and in the mean physical score ( PCS ) and mean mental score ( MCS ) ( p = 0.001 ) . A total of five patients had lower PCS and 13 patients had lower MCS after surgery , but we identified no particular characteristics associated with this poorer outcome . Co-morbidity and preoperative PCS/MCS showed a strong correlation with change in PCS/MCS score . CONCLUSION Gastric bypass had a positive overall effect on HRQOL , but further investigation of individual variations is needed . We found no significant differences in HRQOL outcome between those patients who would be accepted for bariatric surgery under the current Danish criteria for bariatric surgery and those patients who only fulfilled the criteria for bariatric surgery before 2011 . FUNDING not relevant . TRIAL REGISTRATION Clinical Trials.gov : NCT02032199 Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery Introduction Laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) are commonly performed bariatric procedures in obesity management . Gastroesophageal reflux disease ( GERD ) in this population has reported rates of 23–100 % . GERD after LSG has been noted with recent studies demonstrating de novo reflux or symptom exacerbation despite weight loss . Fundoplication is not an option , and medically refractory GERD after LSG is usually treated with conversion to RYGB . GERD post-RYGB is a unique entity , and management poses a clinical and technical challenge . We evaluate safety and effectiveness of magnetic sphincter augmentation after bariatric surgery . Material s and methods A retrospective review of a prospect ively maintained data base was performed identifying patients that underwent LINX placement for refractory GERD after LSG , LRYGB , or duodenal switch across three institutions . Outcomes included complications , length of stay , PPI use , GERD-HRQL scores , and patient overall satisfaction . Results From March 2014 through June 2018 , 13 identified patients underwent LINX placement after bariatric surgery : 8 LSG , 4 LRYGB , and 1 duodenal switch .  The patients were 77 % female , with mean age 43 and average BMI 30.1 .  Average pre-operative DeMeester score was 24.8 . Pre-operatively , 5 patients were on daily PPI , 6 on BID PPI , and 1 on PPI + H2 blocker . We noted decreased medication usage post-operatively , with 4 patients taking daily PPI , and 9 off medication completely . A GERD-HRQL score was obtained pre- and post-operatively in 6 patients with average reduction from 25 to 8.5 ( p value 0.002 ) . Two patients experienced complications requiring endoscopic dilation after LINX placement . 100 % of patients reported overall satisfaction post procedure . Conclusion LINX placement is a safe , effective treatment option for surgical management of refractory GERD after bariatric surgery . It can relieve symptoms and obviate the requirement of high-dose medical management . Magnetic lower esophageal sphincter augmentation should be another tool in the surgeon ’s toolbox for managing reflux after bariatric surgery in select patients BACKGROUND Our objective was to ascertain procedure-related morbidity among  laparoscopic Roux-en-Y gastric bypass ( LRYGB ) , laparoscopic sleeve gastrectomy ( LSG ) , and laparoscopic adjustable gastric b and ing ( LAGB ) patients . These are the 3 most common bariatric procedures performed worldwide . We review ed our experience since the introduction of LSG and compared the procedure-related morbidity among all 3 procedures . STUDY DESIGN We conducted a retrospective review of a prospect ively collected data base of all morbidly obese patients who underwent bariatric surgery between the years 2005 and 2011 . We identified and compared complications , mortality , readmissions , and reoperations in patients who underwent LRYGB , LAGB , and LSG .  RESULTS A total of 2,199 bariatric procedures were performed during this period of time . Of those procedures , 1,327 were  LRYGB  , 619 were LSG , and 253 were LAGB .  Perioperative mortality was not applicable for all 3 procedures . The leak rate was 0.5 % for LRYGB and 0.3 % for LSG , and was not applicable for LAGB . The average number of readmissions postoperatively was less than 2 times for all 3 procedures : LRYGB 1.96 times , LSG 1.49 times , and LAGB 1.54 times . The percentages of procedures requiring reoperations due to complications or failures were 14.6 % in the LAGB group , 6.6 % in the LRYGB group , and 1.8 % in the LSG group . CONCLUSIONS In short- and mid-term follow-up , LSG appears to have the lowest procedure-related morbidity when compared with LRYGB and LAGB OBJECTIVE Increased delivery of bile acid salts ( BA ) to distal L-cells and altered TGR5 receptor activation may contribute to the early and substantial increases in gut peptide secretion seen after bariatric surgery . To further eluci date a potential role of BA in the secretion of GLP-1 and PYY , we analyzed plasma BA concentrations in 14 morbidly obese patients undergoing gastric bypass or sleeve gastrectomy in a prospect i ve , r and omized 1-year trial . DESIGN AND METHODS Patients  received a st and ard test meal and blood was collected before and after eating , prior to , and 1 week , 3 months , and 12 months after surgery . RESULTS Pre-surgery , basal BA concentrations were significantly lower in bariatric patients than in healthy controls . One year post-surgery , bariatric patients expressed variably increased BA concentrations ( gastric bypass patients ∼2 fold increase , P ≤ 0.05 ) . However , whereas in both patient groups , marked increases in GLP-1 and PYY and improved glycemic control was seen already 1 week and 3 months post-surgery , changes in plasma BA followed a different pattern : basal and postpr and ial plasma BA concentrations increased much slower , more progressively with significant increases only 1-year post-surgery . CONCLUSIONS Based on these findings , BA do not appear to be key mediators of the early increase in GLP-1 and PYY response in post-bariatric patients Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation Background In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality . H and washing with soap reduces the risk of infection ; however , h and washing rates in infrastructure-restricted setting s remain low . H and washing stations – a dedicated , convenient location where both soap and water are available for h and washing – are associated with improved h and washing practice s. Our aim was to identify a locally feasible and acceptable h and washing station that enabled frequent h and washing for two subsequent r and omized trials testing the health effects of this behaviour . Methods We conducted formative research in the form of household trials of improved practice s in urban and rural Bangladesh . Seven c and i date h and washing technologies were tested by nine to ten households each during two iterative phases . We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks , depending on the phase . We used the Integrated Behavioural Model for Water , Sanitation and Hygiene ( IBM-WASH ) to guide selection of c and i date h and washing stations and data analysis . Factors presented in the IBM-WASH informed thematic coding of interview transcripts and context ualized feasibility and acceptability of specific h and washing station design s. Results Factors that influenced selection of c and i date design s were market availability of low cost , durable material s that were easy to replace or replenish in an infrastructure-restricted and shared environment . Water storage capacity , ease of use and maintenance , and quality of material s determined the acceptability and feasibility of specific h and washing station design s. After examining technology , psychosocial and context ual factors , we selected a h and washing system with two different water storage capacities , each with a tap , st and , basin , soapy water bottle and detergent powder for pilot testing in preparation for the subsequent r and omized trials . Conclusions A number of context ual , psychosocial and technological factors influence use of h and washing stations at five aggregate levels , from habitual to societal . In interventions that require a h and washing station to facilitate frequent h and washing with soap , elements of the technology , such as capacity , durability and location(s ) within the household are key to high feasibility and acceptability . More than one h and washing station per household may be required . IBM-WASH helped guide the research and research in-turn helped vali date the framework Background Laparoscopic sleeve gastrectomy ( LSG ) is considered a primary bariatric surgery and is increasingly being performed worldwide ; however , long-term data regarding the durability of this procedure are inadequate . Here , we report the long-term results of LSGs in comparison to those of gastric bypass surgeries . Methods A prospect ively collected bariatric data base from Ming-Shen General Hospital was retrospectively studied . Five hundred nineteen morbidly obese patients ( mean age 36.0 ± 9.1 years old ( 14–71 ) , 74.6 % female , mean body mass index ( BMI ) 37.5 ± 6.1 kg/m2 ) underwent LSG as a primary bariatric procedure from 2006 to 2012 at our institute . The operative parameters , weight loss , laboratory data , and quality of life were followed . Another two matched groups of laparoscopic Roux-en-Y gastric bypass ( RYGB ) and laparoscopic single anastomosis ( mini- ) gastric bypass ( SAGB ) patients who were matched in terms of age , sex , and BMI were recruited for comparisons . Results The mean surgical time  for LSG was 113.5 ± 31.3 min , and the mean blood loss was 49.1 + 100.9 ml . The rate of major complications was 1.6 % , and the average length of the postoperative stay was 3.0 ± 1.7 days . The operation times of the RYGB patients were longer than those of both the LSG and SAGB patients . The RYGB and SAGB patients experienced higher major complication rate than the LSG patients . The weight loss of the LSG patient at 5 years was 28.3 + 8.9 % , and the mean BMI was 27.1 + 4.3 . The RYGB patients exhibited a 5-year weight loss similar to the LSG patients , and the SAGB patients exhibited greater weight loss than both of the other groups . Both the RYGB and SAGB patients exhibited significantly better glycemic control and lower blood lipids than the LSG patients , but the LSG patients exhibited a lesser micronutrient deficiency than the RYGB and SAGB groups . All three of the groups exhibited improved quality of life at 5 years after surgery , and there was no significant between-group difference in this measure . Conclusions LSG appears to be an ideal bariatric surgery , and the efficacy of this surgery is not inferior to that of gastric bypass BACKGROUND Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery . METHODS In this r and omized , nonblinded , single-center trial , we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes . The mean ( ±SD ) age of the patients was 49±8 years , and 66 % were women . The average  glycated hemoglobin level was 9.2±1.5 % . The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0 % or less 12 months after treatment . RESULTS Of the 150 patients , 93 % completed 12 months of follow-up . The proportion of patients with the primary end point was 12 % ( 5 of 41 patients ) in the medical-therapy group versus 42 % ( 21 of 50 patients ) in the gastric-bypass group ( P=0.002 ) and 37 % ( 18 of 49 patients ) in the sleeve-gastrectomy group ( P=0.008 ) . Glycemic control improved in all three groups , with a mean glycated hemoglobin level of 7.5±1.8 % in the medical-therapy group , 6.4±0.9 % in the gastric-bypass group ( P<0.001 ) , and 6.6±1.0 % in the sleeve-gastrectomy group ( P=0.003 ) . Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group ( -29.4±9.0 kg and -25.1±8.5 kg , respectively ) than in the medical-therapy group ( -5.4±8.0 kg ) ( P<0.001 for both comparisons ) . The use of drugs to lower glucose , lipid , and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) improved significantly after bariatric surgery . Four patients underwent reoperation . There were no deaths or life-threatening complications . CONCLUSIONS In obese patients with uncontrolled type 2 diabetes , 12 months of medical therapy plus bariatric surgery  achieved glycemic control in significantly more patients than medical therapy alone . Further study will be necessary to assess the durability of these results . ( Funded by Ethicon Endo-Surgery and others ; Clinical Trials.gov number , NCT00432809 . ) OBJECTIVE This study aim ed to develop and test a novel mindfulness-based intervention ( MBI ) design ed to control weight after bariatric surgery . DESIGN R and omized , controlled pilot trial . SETTING Beth Israel Deaconess Medical Center , Boston , MA , USA . INTERVENTIONS Bariatric patients 1 - 5 years post-surgery ( n=18 ) were r and omized to receive a 10-week MBI or a st and ard intervention . MAIN OUTCOME MEASURES Primary outcomes were feasibility and acceptability of the MBI . Secondary outcomes included changes in weight , eating behaviors , psychosocial outcomes , and metabolic and inflammatory biomarkers . Qualitative exit interviews were conducted post-intervention . Major themes were coded and extracted . RESULTS Attendance was excellent ( 6 of 9 patients attended ≥7 of 10 classes ) . Patients reported high satisfaction and overall benefit of the MBI . The intervention was effective in reducing emotional eating at 6 months ( -4.9±13.7 in mindfulness vs. 6.2±28.4 in st and ard , p for between-group difference=0.03 ) but not weight . We also observed a significant increase in HbA1C ( 0.34±0.38 vs. -0.06±0.31 , p=0.03 ) . Objective measures suggested trends of an increase in perceived stress and symptoms of depression , although patients reported reduced stress reactivity , improved eating behaviors , and a desire for continued mindfulness-based support in qualitative interviews . CONCLUSIONS This novel mindfulness-based approach is highly acceptable to bariatric patients post-surgery and may be effective for reducing emotional eating , although it did not improve weight or glycemic control in the short term . Longer-term studies of mindfulness-based approaches may be warranted in this population . CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifier NCT02603601 SUMMARY Bariatric surgery ( BS ) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date . Although BS interventions are effective , 20 - 30 % of BS patients start to regain weight within 24 months . Emotional eating is a behavior pattern which has been found to predict poor outcome . The aim of this study is to evaluate the effects of acceptance and commitment therapy  ( ACT ) for patients who underwent BS  , with regard to emotional eating , body dissatisfaction and quality of life . This study is a r and omized controlled trial ( n = 39 ) with two conditions ( 1 ) ACT including two face-to-face sessions and support via an Internet application and ( 2 ) treatment as usual ( TAU ) comprising the st and ard follow-up used by the BS team . Results show that participants in the ACT condition significantly improve on eating disordered behaviors , body dissatisfaction , quality of life and acceptance for weight related thoughts and feelings , as compared to those in the TAU group . This study shows that it is possible to improve effects of  BS  by specifically targeting emotional eating behavior . Background Many insurance payors m and ate that bariatric surgery c and i date s undergo a medically supervised weight management ( MSWM ) program as a prerequisite for surgery . However , there is little evidence to support this requirement . We evaluated in a r and omized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric b and ing ( LAGB ) in a publicly insured population . Methods This pilot r and omized trial was conducted in a large academic urban public hospital . Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a m and atory 6-month MSWM program  were r and omized to a MSWM program with monthly visits over 6 months ( individual or group ) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively . Demographics , weight , and patient behavior scores , including patient adherence , eating behavior , patient activation , and physical activity , were collected at baseline and at 6 months ( immediately preoperatively and postoperatively ) . Results A total of 55 patients were enrolled in the study with complete follow-up on 23 patients . Participants r and omized to a MSWM program attended an average of 2 sessions preoperatively . The majority of participants were female and non-Caucasian , mean age was 46 years , average income was less than $ 20,000/year , and most had Medicaid as their primary insurer , consistent with the demographics of the hospital ’s bariatric surgery program . Data analysis included both intention-to-treat and completers ’ analyses . No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively , suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB . Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively . Conclusion MSWM does not appear to confer additional benefit as compared to the st and ard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative BACKGROUND Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone . In an analysis of data from a nonr and omized , prospect i ve , controlled study , we examined the effects of bariatric surgery on the prevention of type 2 diabetes . METHODS In this analysis , we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls ( with matching performed on a group , rather than individual , level ) . None of the participants had diabetes at baseline . Patients in the bariatric-surgery cohort underwent b and ing  ( 19 % ) , vertical b and ed gastroplasty ( 69 % ) , or gastric bypass ( 12 % ) ; nonr and omized , matched , prospect i ve controls received usual care . Participants were 37 to 60 years of age , and the body-mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) was 34 or more in men and 38 or more in women . This analysis focused on the rate of incident type 2 diabetes , which was a prespecified secondary end point in the main study . At the time of this analysis ( January 1 , 2012 ) , participants had been followed for up to 15 years . Despite matching , some baseline characteristics differed significantly between the groups ; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group . At 15 years , 36.2 % of the original participants had dropped out of the study , and 30.9 % had not yet reached the time for their 15-year follow-up examination . RESULTS During the follow-up period , type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group , corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years , respectively ( adjusted hazard ratio with bariatric surgery , 0.17 ; 95 % confidence interval , 0.13 to 0.21 ; P<0.001 ) . The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose ( P=0.002 for the interaction ) but not by BMI ( P=0.54 ) . Sensitivity analyses , including end-point imputations , did not change the overall conclusions . The postoperative mortality was 0.2 % , and 2.8 % of patients who underwent bariatric surgery required reoperation within 90 days owing to complications . CONCLUSIONS Bariatric surgery appears to be markedly more efficient than usual care in the prevention of  type 2 diabetes in obese persons . ( Funded by the Swedish Research Council and others ; Clinical Trials.gov number , NCT01479452 . ) Abstract Introduction Vertical b and ed gastroplasty ( VBG ) has been the procedure of choice for bariatric surgeries since the 1980s . However , long-term results of VBG have been reported with different opinions , and new restrictive procedures have been innovated and showing variable results . The aim of this study is to analyze the long-term results of our VBG patients .Patient and methods Between June 1998 and May 2002 , 652 morbidly obese patients received VBG , with the initial 40 patients having open procedures and the subsequent 612 patients using a laparoscopic approach .  Operative complications , weight loss , and late complications were followed and compared with groups of laparoscopic adjustable gastric b and ing ( LAGB ) and sleeve gastrectomy ( LSG ) . Results Mean age , preoperative weight , and body mass index ( BMI ) were 30.96 years , 108.83 kg , and 40.63 kg/m2 , respectively . The overall early postoperative complication rate was 3.4 % ( 22/652 ) . The excess weight loss percentages at 1 , 2 , 5 , and 10 years were 61.04 , 59.70 , 51.11 , and 42.0 % , respectively . BMI at 1 , 2 , 5 , and 10 years were 29.64 , 29.71 , 31.33 , and 31.73 kg/m2 , respectively . This result is inferior to the 67 % excess weight loss in the LSG group , but is higher than the 38 % excess weight loss of the LAGB group . The revision rate is 13.19 % ( 86/652 ) up to now . Revision surgery was required in 28 ( 14.0 % ) patients in the LAGB group and 8 ( 1.3 % ) in the LSG group . Conclusion VBG was an operation with acceptable outcome for treating morbid obesity and metabolic disorders . It sets a st and ard for new restrictive procedures BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical Background : Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution . R and omized trials design ed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed . Methods : In this r and omized , single-center , nonblinded trial , we included patients with hypertension ( using ≥2 medications at maximum doses or > 2 at moderate doses ) and a body mass index between 30.0 and 39.9 kg/m2 . Patients  were r and omized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone . The primary end point was reduction of ≥30 % of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure < 140 mm Hg and 90 mm Hg , respectively , at 12 months . Results : We included 100 patients ( 70 % female , mean age 43.8±9.2 years , mean body mass index 36.9±2.7 kg/m2 ) , and 96 % completed follow-up .  Reduction of ≥30 % of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group ( 83.7 % ) compared with 6 of 47 patients ( 12.8 % ) from the control group with a rate ratio of 6.6 ( 95 % confidence interval , 3.1–14.0 ; P<0.001 ) . Remission of hypertension was present in 25 of 49 ( 51 % ) and 22 of 48 ( 45.8 % ) patients r and omized to gastric bypass , considering office and 24-hour ambulatory blood pressure monitoring , respectively , whereas no patient su bmi tted to medical therapy was free of antihypertensive drugs at 12 months . A post hoc analysis for the primary end point considering the SPRINT ( Systolic Blood Pressure Intervention Trial ) target reached consistent results , with a rate ratio of 3.8 ( 95 % confidence interval , 1.4–10.6 ; P=0.005 ) . Eleven patients ( 22.4 % ) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives . Waist circumference , body mass index , fasting plasma glucose , glycohemoglobin , low-density lipoprotein cholesterol , triglycerides , high-sensitivity C-reactive protein , and 10-year Framingham risk score were lower in the gastric bypass than in the control group . Conclusions : Bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients with obesity and hypertension . Clinical Trial Registration : URL : https:// clinical trials.gov . Unique identifier : NCT01784848 INTRODUCTION Favourable short-term results , with respect to less postoperative pain and earlier return to physical activity , have been demonstrated with  laparoscopic totally extraperitoneal ( TEP ) hernia repair compared with open mesh repair . However , there is limited data regarding long-term results . PATIENTS AND METHODS The study cohort consisted of 275 consecutive patients undergoing TEP repair between 1996 and 2002 . Patient demographics , details of surgery , postoperative complications , recurrence and chronic pain were collected from patient records and from a prospect i ve data base . All patients were seen at 6 weeks and then annually for 5 years following surgery . RESULTS A total of 430 repairs were performed in the 275 patients ( median age , 56 years ; range , 20 - 94 years ; men , 97.5 % ) . Bilateral repair was performed in 168 patients ( 61.1 % ) and recurrent hernia repair in 79 patients ( 28.7 % ) . Two patients were converted to an open procedure . Five-year follow-up was achieved in 72 % of patients . Eleven patients ( 4 % ) died during the follow-up period due to unrelated causes . Hernia recurrence rate at 5 years was 1.1 % per patient ( three repairs ) . Recurrences were noted at 7 months , 2 years and 4 years following surgery . Chronic groin pain was reported by 21 patients ( 7.6 % ) , seven of whom required referral to the pain team . CONCLUSIONS TEP hernia repair is associated with a recurrence rate of 1 % at 5 years in this series . Chronic groin symptoms are also acceptably few . This recurrence rate following TEP repair compares extremely favourably with open mesh repair , particularly as it includes a high proportion of recurrent repairs . As well as the proven early benefits , TEP repair can be considered a safe and durable procedure with excellent long-term results BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes Background The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service ( BRS ) on  patient weight loss following bariatric surgery  at 1 year . Methods A single-site open-r and omised parallel group control trial based at St. Richard ’s Hospital in Chichester in the UK . Patients ( n = 162 ) were recruited immediately prior to Roux-en-Y gastric bypass  and r and omly allocated to receive either treatment as usual ( n = 80 ) or the BRS ( n = 82 ) . The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information , support and mentoring pre and post surgery addressing psychological issues such as dietary control , self esteem , coping and emotional eating . Weight loss was assessed at 1 year . The key outcome variable was BMI and change in BMI . Results Follow-up weight was available for 145 patients . Intention-to-treat analysis ( n = 162 ) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49 . There was no significant difference between the two groups ( control group = −16.37 , 95 % CI = 15.15–17.57 ; intervention = −16.6 , 95 % CI = 15.42–17.81 ; ηp2 = 0.001 ) . Similarly , explanatory analysis ( n = 145 ) showed a mean change in BMI of −17.17 . The difference between the two groups was not significant ( control group = −16.9 , 95 % CI = 15.78–18.18 ; intervention = −17.35 , 95 % CI = 18.5–16.16 ; ηp2 = 0.001 ) . Conclusions Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year . It is argued that psychological support should be targeted to patients who start to demonstrate  weight regain at a later stage . Trial registration : Clinical Trials.gov NCT01264120 Durability of Benefits of an  Outpatient Antimicrobial Stewardship Intervention  After Discontinuation of Audit and Feedback Antibiotics are the most frequently prescribed medications for children1 ; most are prescribed for outpatient acute respiratory tract infections.2 Because antibiotic prescribing is often inappropriate,2,3 we recently conducted a cluster r and omized trial of an  outpatient antimicrobial stewardship intervention that found a nearly 50 % relative reduction in presc ribing rates for broad-spectrum antibiotics.4 To assess the durability of this intervention , we followed antibiotic prescribing across intervention and control sites for 18 months after termination of audit and feedback BACKGROUND To improve decision making in the treatment of extreme obesity , the risks of bariatric surgical procedures require further characterization . METHODS We performed a prospect i ve , multicenter , observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007 . A composite end point of 30-day major adverse outcomes ( including death ; venous thromboembolism ; percutaneous , endoscopic , or operative reintervention ; and failure to be discharged from the hospital ) was evaluated among patients undergoing first-time bariatric surgery .  RESULTS There were 4776 patients who had a first-time bariatric procedure ( mean age , 44.5 years ; 21.1 % men ; 10.9 % nonwhite ; median body-mass index [ the weight in kilograms divided by the square of the height in meters ] , 46.5 ) . More than half had at least two coexisting conditions . A Roux-en-Y gastric bypass was performed in 3412 patients ( with 87.2 % of the procedures performed laparoscopically ) , and laparoscopic adjustable gastric b and ing was performed in 1198 patients ; 166 patients underwent other procedures and were not included in the analysis . The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing was 0.3 % ; a total of 4.3 % of patients had at least one major adverse outcome . A history of deep-vein thrombosis or pulmonary embolus , a diagnosis of obstructive sleep apnea , and impaired functional status were each independently associated with an increased risk of the composite end point . Extreme values of body-mass index were significantly associated with an increased risk of the composite end point , whereas age , sex , race , ethnic group , and other coexisting conditions were not . CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics . In helping patients make appropriate choices , short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese . ( Clinical Trials.gov number , NCT00433810 .
Reoperations were common in all groups .
Reoperation rate was initially high but reduced markedly with improved b and and surgical and aftercare techniques .
Conclusion All current procedures are associated with substantial and durable weight loss .
More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy  .
Reoperation is likely to remain common across all procedures
Introduction Durability is a key requirement for the broad acceptance of bariatric surgery .