BACKGROUND: Obesity is associated with increased morbidity and mortality. Surgery for morbid @entity28 may be considered when other conventional measures have failed, and a number of procedures are available. However, the effects of these surgical procedures compared with medical management and with each other are uncertain. OBJECTIVES: To assess the effects of surgery for morbid @entity28 on weight, comorbidities and quality of life. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (issue 4, 2001), Medline ( @entity575 Platter) up to 2001, PubMed (Internet) 01/01/01-19/10/01, Embase (SilverPlatter) up to 09/2001, PsychINFO up to 10/2001, CINAHL (SilverPlatter) up to 07/2001, Science and Social Sciences Citation Index up to 10/12001, British Nursing Index up to 07/2001, Web of Science Proceedings up to 06/2001, BIOSIS up to10/2001, AMED up to 07/2001, National Research Register (issue 2, 2001), reference lists of relevant articles, and handsearched relevant journals. We also contacted experts in the field. Date of the most recent searches: October 2001. SELECTION CRITERIA: Randomised controlled trials comparing different surgical procedures, and randomised controlled trials and non-randomised controlled trials comparing surgery with non-surgical management for morbid @entity28 . DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed trial quality. MAIN RESULTS: 18 trials involving 1891 @entity1 were included. One randomised controlled trial and one non-randomised controlled trial compared surgery with non-surgical management, and 11 randomised controlled trials compared different surgical procedures. The overall quality of the trials was variable, with just one trial having adequate allocation concealment. A meta-analysis was not possible due to differences in the surgical procedures performed, measures of weight change and length of follow-up. Compared with conventional management, surgery resulted in greater @entity353 (23-28 kg more @entity353 at two years), with improvements in quality of life and comorbidities. Some complications of surgery occurred, such as @entity2737 . Gastric bypass was associated with greater @entity353 and fewer revisions, reoperations and/or conversions than gastroplasty, but had more side-effects. Greater @entity353 and fewer side-effects and reoperations occurred with adjustable gastric banding than vertical banded gastroplasty, while vertical banded gastroplasty was associated with greater @entity353 but more @entity391 than horizontal gastroplasty. Some @entity204 occurred in the studies. Weight loss was similar between open and laparoscopic procedures. Fewer serious complications occurred with laparoscopic surgery. Laparoscopic surgery had a longer operative time, but resulted in reduced @entity190 , reduced proportion of @entity1 requiring intensive care unit stay, reduced length of hospital stay, reduced days to return to activities of daily living and reduced days to return to work. REVIEWER'S CONCLUSIONS: The limited evidence suggests that surgery is more effective than conventional management for @entity353 in morbid @entity28 . The comparative safety and effectiveness of different surgical procedures is unclear.

Surgery for morbid XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'people'] @entity353 :: ('MESH:D015431', 'Disease') :: ['weight loss'] @entity28 :: ('MESH:D009765', 'Disease') :: ['obesity'] @entity575 :: ('MESH:D012834', 'Chemical') :: ['Silver'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting'] @entity2737 :: ('MESH:D014946', 'Disease') :: ['wound infection'] @entity204 :: ('MESH:D003643', 'Disease') :: ['postoperative deaths']
@entity28 :: (MESH:D009765,Disease) :: ['obesity']
