Bariatric surgery appears efficacious compared to st and ard care in reducing BMI .
Weight losses are greatest with diversionary procedures , intermediate with diversionary/restrictive procedures , and lowest with those that are purely restrictive .
Compared with Roux-en-Y gastric bypass , adjustable gastric b and ing has lower weight loss efficacy , but also leads to fewer serious adverse effects
Results of the surgical treatment of obesity.
A prospect i ve , r and omized trial comparing vertical b and ed gastroplasty ( VBG ) and vertical gastric bypass ( GB ) for obesity was completed in 106 patients who did not differ in baseline body mass index ( BMI = kg/m2 ) or length of follow-up . The goal of this surgery was to return patients to within 50 % of their ideal weight , i.e. , a body mass index less than 35 kg/m2 , and to accomplish this while maintaining a low risk for malnutrition as well as other morbidity and mortality . Success was defined as a BMI less than 35 kg/m2 because the mortality risk increases rapidly above this degree of obesity . Surgical failures were encountered in 43 % of the 54 patients in the VBG group , all of whom had division between the vertical staple lines . The main causes of failure were stenosis and enlargement of the gastroplasty orifice . Surgery failed in 23 % of the GB-treated patients , due to perforation of the vertical staple line . An  isolated gastric bypass ( IGB )  not dependent on staples was performed as the remedial operation for the failures of both VBG and GB . IGB was significantly better than VBG or GB , with a success rate of 83 % compared with 39 % for VBG and 58 % for GB . Subsequent experience since completion of this r and omized trial in 54 consecutive patients supports IGB for primary , as well as remedial , operations for the morbidly obese ( BMI = 40 to 50 kg/m2 ) , as well as for patients who are super obese ( BMI greater than 50 kg/m2 )
Bariatric surgery appears efficacious compared to st and ard care in reducing BMI .
Weight losses are greatest with diversionary procedures , intermediate with diversionary/restrictive procedures , and lowest with those that are purely restrictive .
Compared with Roux-en-Y gastric bypass , adjustable gastric b and ing has lower weight loss efficacy , but also leads to fewer serious adverse effects