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PubMed1987

Pulmonary function in morbid obesity.

Morbid obesity is not infrequently associated with severe respiratory impairment. In our experience approximately 10 per cent of morbidly obese patients who underwent gastric surgery had severe respiratory impairment. Respiratory insufficiency of obesity can be divided into two primary breathing disorders: the obstructive sleep apnea syndrome (SAS) and the obesity hypoventilation syndrome (OHS). In its most severe form, when both SAS and OHS are present, it is called the Pickwickian syndrome. In our series 59 morbidly obese patients with respiratory insufficiency secondary to obesity underwent gastric surgery for weight reduction. Fourteen had OHS, 19 had SAS and 26 had both. Of these, two patients died of postoperative complications and one died at five weeks with an inconclusive autopsy, totalling an operative mortality rate of 3.4 per cent and a total mortality of 5.1 per cent. In our overall experience morbidly obese patients lost 67 per cent of excess weight after gastric procedures. In conclusion, surgically induced weight loss will markedly improve or correct respiratory insufficiency secondary to obesity. It will improve arterial oxygenation, minimize CO2 retention, expand lung volumes, correct polycythemia, and reduce apnea frequency. The magnitude of changes in these variables is clinically significant. Therefore, respiratory insufficiency of obesity should be considered a major indication for an aggressive approach to weight reduction. The jejunoileal bypass and unbanded gastroplasty operations have an unacceptable incidence of complications or failure, respectively. There is a high degree of recidivism following dietary programs. Sweets eaters will not do well with a gastroplasty procedure. Gastric bypass for individuals addicted to sweets or the vertical banded gastroplasty for "gorgers" are currently our procedures of choice and are associated with the average loss of two thirds of excess weight and correction of breathing problems associated with morbid obesity.

Anesthesia↗
PubMed1983

Estimating morbidity risks with variable age of onset: review of methods and a maximum likelihood approach.

Various methods for the estimation of morbidity risk in a disease with late variable onset are described, along with a maximum likelihood approach. It is shown that the Strömgren estimator is nearly as efficient as the maximum likelihood estimator when the true risk is low, but may be significantly less efficient for high morbidity risks. The maximum likelihood estimator offers greater protection against risk estimates greater than or equal to 1, and for small samples, may also be less biased than the Strömgren estimator, especially when risk is high. For reasonable sample sizes both estimates are nearly unbiased. The modified Strömgren estimator is too biased, in general, to be practical. Methods for comparing morbidity risks are also described. If an age-of-onset distribution is estimated from the same sample as morbidity risk, a single maximum likelihood procedure is advocated. The methods are applied to a data set on major affective disorder. The sensitivity of morbidity-risk estimates and tests of hypotheses to the form of onset function assumed is examined.

Age Factors↗
PubMed1995

[Changes and trend prediction in cancer morbidity of urban residents in Beijing].

Data from a long-term cancer morbidity registry and notification system were analyzed dynamically. A theoretical model of grey system was established based on time-series changes in cancer morbidities to predict its trend by the year of 2001 in Beijing. Results show cancer morbidities in Beijing will increase yearly from 1991 to 2001, and overall morbidity rate of malignant tumor will increase to 179.9/100,000 from 162.5/100,000. Proportions of malignant tumor in different sites will change greatly. Morbidities of lung cancer and breast cancer will increase rapidly, of liver and colon-rectal cancer shoes an increasing trend, too, of esophageal and cervical cancer will decline steadily, and of stomach cancer will begin to decline. All these facts laid a scientific basis for the study on cancer prevention and control.

Breast Neoplasms↗
PubMed1993

Severe morbidity among children in a trial malaria chemoprophylaxis with pyrimethamine or chloroquine in Ibarapa, Nigeria.

In a controlled trial of weekly malaria chemoprophylaxis with chloroquine and pyrimethamine there were no significant differences in type and frequency of severe morbidity during chemoprophylaxis. Administration of chemoprophylaxis during the current and immediately preceding month was associated with significantly fewer episodes of severe morbidity in the chloroquine and pyrimethamine groups when each was compared with the control multivite group. After chemoprophylaxis had been stopped, significantly more episodes of severe morbidity occurred in the chloroquine group than the control group, but a similar trend in the pyrimethamine group was not statistically significant. In the control group most of the episodes of severe morbidity, including those episodes which were associated with heavy parasitaemia, occurred below the age of 4 years. In contrast, the children who received chemoprophylaxis continued to experience such illness at older ages. The difference between the chloroquine group and the control group in respect of age at time of severe morbidity was statistically significant.

Age Factors↗
PubMedDate not supplied

Morbidity and mortality of dialysis.

The National Institutes of Health Consensus Development Conference on Morbidity and Mortality of Dialysis brought together experts in general medicine, nephrology, pediatrics, biostatistics, and nutrition as well as the public to address the following questions: (1) How does early medical intervention in predialysis patients influence morbidity and mortality? (2) What is the relationship between delivered dialysis dose and morbidity/mortality? (3) Can co-morbid conditions be altered by non-dialytic interventions to improve morbidity/mortality in dialysis patients? (4) How can dialysis-related complications be reduced? and (5) What are the future directions for research in dialysis? Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighted the evidence and prepared their consensus statement. Among their findings, the consensus panel concluded that (1) patients in the predialysis phase, including children, should be referred to a renal team in an effort to reduce the morbidity and mortality incurred both during the predialysis period and when receiving subsequent dialysis therapy; (2) the social and psychological welfare and the quality of life of the dialysis patient are favorably influenced by the early predialytic and continued involvement of a multidisciplinary renal team; (3) attempts should be made to avoid a catastrophic onset of dialysis by instituting predialytic intervention and the appropriate initiation of dialysis access; (4) quantitative methods now available to objectively evaluate the relationship between delivered dose of dialysis and patient morbidity and mortality suggest that the dose of hemodialysis and peritoneal dialysis has been suboptimal for many patients in the United States; (5) factors contributing to underdialysis of some patients include problems with vascular and peritoneal access, nonadherence to dialysis prescription, and underprescription of the dialysis dose; (6) cardiovascular mortality accounts for approximately 50 percent of deaths in dialysis patients, and relative risk factors such as hypertension, smoking, and chronic anemia should be treated as soon as possible after diagnosis of chronic renal failure; (7) early detection and treatment of malnutrition contribute to improved survival of patients on dialysis; and (8) until prospective, randomized, controlled trials have been completed, a delivered hemodialysis dose at least equal to a measured fractional urea clearance of Kdrt/V of 1.2 (single pool) and a delivered peritoneal dialysis dose at least equal to a measured Kprt/V of 1.7 (weekly) are recommended.

Adult↗
PubMed1993

Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index.

OBJECTIVE: To evaluate the relationship between the ankle/arm blood pressure index (AAI, the ratio of ankle to arm systolic blood pressure, a measure of peripheral arterial disease) and short-term cardiovascular morbidity and mortality in older adults with systolic hypertension. DESIGN: Prospective cohort study, 1- to 2-year follow-up (mean, 16 months). SETTING: Eleven of 16 field centers from the Systolic Hypertension in the Elderly Program. PARTICIPANTS: 1537 older men and women with systolic hypertension. MAIN OUTCOME MEASURES: All-cause mortality, coronary heart disease (CHD) mortality, cardiovascular disease (CVD) mortality, and CHD and CVD morbidity and mortality. RESULTS: The AAI was measured at the 1989-1990 clinic examination and was 0.9 or less in 25.5% of 1537 participants. A low AAI was associated with most major CHD and CVD risk factors. In those with a low AAI (< or = 0.9) compared with those with an AAI of more than 0.9, age- and sex-adjusted relative risks for mortality end points at follow-up were as follows: total mortality, 3.8 (95% confidence interval [CI], 2.1 to 6.9); CHD mortality, 3.24 (95% CI, 1.4 to 7.5); and CVD mortality, 3.7 (95% CI, 1.8 to 7.7). For CVD morbidity and mortality, the age- and sex-adjusted relative risk was 2.5 (95% CI, 1.5 to 4.3). After adjustment for baseline CVD and other cardiovascular risk factors, the relative risk for total mortality was 4.1 (95% CI, 2.0 to 8.3) and for CVD morbidity and mortality, 2.4 (95% CI, 1.3 to 4.4). Results were similar when participants with clinical CVD at baseline were excluded. CONCLUSION: A low AAI appears to be an important predictor of morbidity and mortality among older adults with systolic hypertension.

Aged↗
PubMed1993

Comparison of morbidity in cesarean section hysterectomy versus cesarean section tubal ligation.

This study was undertaken to compare the morbidity of cesarean section hysterectomy (C-HYST) and cesarean section bilateral tubal ligation (C-BTL) in a nonemergency or elective environment. Charts were reviewed for patients who underwent elective C-HYST or elective C-BTL before the onset of labor, without the use of antibiotics. Demographics, maternal morbidity, operative difficulties and postoperative complications were compared. Statistically significant differences in patient demographics include a higher maternal age in the C-HYST group than for those in the C-BTL group (31.0 +/- 5.8 versus 27.7 +/- 5.4 years; p = 0.002). C-BTL patients had higher gestational ages (39.4 +/- 1.6 versus 38.7 +/- 1.3 years; p = 0.0017). The C-HYST group had a higher estimated blood loss (1,201 +/- 472 versus 718 +/- 364 milliliters; p = 0.001), change in hematocrit level (6.0 +/- 4.4 percent versus 4.5 +/- 3.4 percent; p = 0.013) and operating time (115 +/- 37 versus 74 +/- 26 minutes; p = 0.0001). Blood transfusion was similar in both groups. Febrile morbidity was higher in the C-BTL group (68.0 percent versus 50.0 percent; p = 0.01). Endometritis was the significant determinant of febrile morbidity for the C-BTL group (41.7%) and cuff cellulitis in the C-HYST group (25.6 percent). Intraoperative and postoperative complications between the two groups were rare and not statistically different. Clinical morbidity for C-HYST is not significantly different than C-BTL. Elective C-HYST may be used in place of C-BTL when indications for hysterectomy are present.

Adult↗
PubMed1993

Morbid obesity: a comparison between a general population and obesity surgery patients.

Characteristics of morbidity obese adults in the general population and morbidly obese adults presenting for obesity surgery were compared. Black morbidly obese women in the general population were less obese than black women obesity surgery patients, showed less emotional distress, and had fewer abnormal eating behaviours; age and socio-economic status were similar. A greater proportion of morbidly obese surgery patients were white women than would be expected either on the basis of the prevalence of morbid obesity in the general population or on census data. It was hypothesized that black women and white men avoid obesity surgery until they are physically debilitated by their overweight, while white women elect for obesity surgery when the emotional distress associated with obesity becomes debilitating.

Adult↗
PubMed1993

Trends in malaria morbidity and mortality in Sri Lanka.

Trends since 1930 in malaria morbidity and mortality in Sri Lanka were analysed. The Malaria Control Programme, which began in 1945 with DDT spraying, was associated with a 100-fold reduction in morbidity and mortality over the following ten years, and gave way to the Malaria Eradication Programme in 1958. DDT spraying ceased in 1964 and a vivax malaria epidemic in 1968 returned to the island to 1952 morbidity levels, though with little mortality. After the discovery of DDT resistance in 1969, malathion spraying took over in 1973, and USAID-assisted control programme, involving case-detection and treatment, started in 1977. However, morbidity levels comparable to 1952 levels were observed in 1975 and 1986 when falciparum malaria morbidity levels were especially high. Mortality rates since 1960 have however remained lower than at any other previous time.

History, 20th Century↗
PubMed1993

Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity.

OBJECTIVE: To determine the incidence of gestational diabetes and its associated maternal and infant morbidity by two sets of 3-hour glucose tolerance test criteria, those recommended by the National Diabetes Data Group or the lower, modified criteria of Carpenter and Coustan. DESIGN: Prospective, observational outcome cohort study. SETTING: Prepaid health maintenance organization. SUBJECTS: A total of 2019 pregnant women preregistered in a health maintenance organization were screened for a plasma glucose of 7.77 mmol/L (140 mg/dL) or greater, 1 hour after ingestion of a 50-g glucose drink administered after an overnight fast. Positive subjects received a 3-hour glucose tolerance test interpreted by the two criteria. Data are presented for 521 randomly selected negative screenees; 264 positive screen, negative glucose tolerance test subjects; and 101 subjects with gestational diabetes mellitus. OUTCOME MEASURES: Maternal risk factors for diabetes, infant birth weight corrected for gestational age (birth-weight ratio), umbilical cord serum insulin levels, and 33 maternal and infant perinatal morbidities assessed from chart review. RESULTS: Gestational diabetes incidence was 5.0% overall based on the modified criteria and 3.2% by the recommended criteria. Maternal age and family history of diabetes were higher in both modified and recommended groups. Birthweight ratio was 1.05 in negative screenees, 1.09 in gestational diabetes overall (P < .05 when only diet-treated subjects were considered), and 1.11 in modified and 1.08 in recommended criteria groups. Cord serum insulin levels in infants of gestational diabetic mothers by both criteria were 40% above those of negative screenees (P < .001). The average percentage incidence of 33 possible perinatal morbidities was 41% higher in gestational diabetic pregnancies by the modified criteria. The cumulative number of morbidities was higher in both modified and recommended criteria groups (P < .01 in both instances). In contrast, subjects having a positive glucose screening test but a negative glucose tolerance test by modified criteria had none of the characteristics of gestational diabetes with the single exception of greater age. CONCLUSIONS: Fifty percent more cases of gestational diabetes were identified using the more inclusive, modified criteria. These cases had as much excess in maternal diabetes risk factors, infant macrosomia, and cord hyperinsulinemia and nearly as much increase in perinatal morbidity as subjects diagnosed by the recommended criteria. The incidence and perinatal impact of gestational diabetes may be greater than previously appreciated. The modified criteria deserve wider verification and use.

Adult↗
PubMed1993

The perioperative morbidity of scheduled cesarean hysterectomy.

OBJECTIVE: To compare the outcomes of patients undergoing scheduled cesarean hysterectomy with those of women treated with cesarean delivery and subsequent hysterectomy. METHODS: Through a retrospective review of 43 patients, we investigated the morbidity associated with scheduled cesarean hysterectomy and compared these findings with the combined morbidity of scheduled cesarean delivery and subsequent abdominal hysterectomy in a control population. Controls were included only if the subsequent hysterectomy was performed within 3 years of the index cesarean delivery. Each study subject was assigned two controls matched for age, parity, number of previous cesarean deliveries, and indications for procedures. The incidence of the following major morbidity events was compared between the groups: transfusion, urinary tract injury, fistula formation, cellulitis or endometritis, postoperative abscess or hematoma formation, ileus, pneumonia, and wound complications requiring prolonged therapy (seroma, hematoma, infection). RESULTS: The number of women receiving transfusions after scheduled cesarean hysterectomy was greater than among controls (39.5 versus 15.1%; P < .05). The proportion of patients with major morbidity, exclusive of transfusion, was significantly greater in the control population (44%) than in women with scheduled cesarean hysterectomy (16%) (P < .05). The cumulative number of women with a major complication, such as transfusion or a morbid event, was 22 of 43 in the study group versus 44 of 86 in the control population, a nonsignificant difference. CONCLUSION: We found no significant difference in the cumulative perioperative complication rates in women undergoing scheduled cesarean hysterectomy compared with a population of similar patients treated with cesarean delivery and subsequent abdominal hysterectomy.

Adult↗
PubMed1993

Open cholecystectomy: its morbidity and mortality as a reference standard.

In a retrospective study of 10,471 cholecystectomies, performed between 1971 and 1990, the incidence and causes of death and morbidity of cholecystectomy were analysed. There were 47 postoperative deaths (0.4%); 6 deaths occurred in 5841 patients less than 50 years old, 23 in 3898 patients between 50 and 70 years old and 18 in 732 patients more than 70 years old. Death rates in each group were, respectively, 0.1%, 0.6% and 2.5% (p < 0.001). The death rate in 9339 patients who had cholecystectomy alone was 0.3% and the death rate in 1132 patients who had a concomitant common bile duct exploration (CBDE) was 1.6% (p < 0.001). Cardiovascular complications were the main cause of death, and biliary, pulmonary and wound complications were the most common. There were 614 complications in 529 patients; 176 of these patients were less than 50 years old, 252 were between 50 and 70 years old and 101 were more than 70 years old. Complication rates were, respectively, 3.0%, 6.5% and 13.8% (p < 0.001). For patients with cholecystectomy alone the morbidity was 3.6% and for patients who had a concomitant CBDE the morbidity was 17% (p < 0.001). The mortality and morbidity of cholecystectomy increase significantly with age and a concomitant CBDE. However, patients who underwent cholecystectomy electively or for acute cholecystitis had comparable mortality and morbidity.

Acute Disease↗
PubMed1996

Polymorphism of the beta 3-adrenergic receptor gene in morbid obesity.

OBJECTIVE: The Trp64-->Arg allele of the beta 3-adrenergic receptor gene was recently proposed to be associated with an earlier onset of non-insulin-dependent diabetes mellitus (NIDDM), features of insulin resistance and a tendency to gain weight. We investigated whether the Arg64 allele predisposes to severe obesity. DESIGN AND SUBJECTS: A genetic association study of 254 subjects with morbid obesity [body-mass index (BMI) > or = 40; mean 42.8 +/- 7.0] and 151 lean healthy control subjects [BMI < or = 25; mean BMI 22.3 +/- 1.9]. MEASUREMENTS: beta 3-adrenergic receptor genotyping was carried out with a solid-phase minisequencing technique. Serum lipids, glucose and insulin levels in the obese subjects were also determined. RESULTS: The frequency of the Arg64 did not significantly differ in the morbidly obese patients (9.1%) and lean controls (8.9%), nor was there any statistically significant association between the mean BMI values and the beta 3-adrenergic receptor genotype. However, obese subjects carrying the Arg64 allele developed obesity more often before the age of 15 y than those without it (P < 0.05, adjusted for multiple comparisons). The frequency of the Arg64 allele was similar in nondiabetic and diabetic patients; the mean age at the onset of NIDDM did not differ according to the beta 3-adrenergic receptor genotype. There was no significant association between the receptor genotype and the level of the serum cholesterol, HDL-cholesterol, triglyceride, glucose or insulin, nor was this polymorphism associated with the behavioural or psychopathological characteristics of the morbidly obese subjects. Response to a 16 w treatment program including a very-low calorie diet (VLCD) regimen, dietary and exercise counseling, as well as behavioural modifications, did not differ according to the genotype. CONCLUSION: Our data do not support a significant role for the codon 64 polymorphism of the beta 3-adrenergic receptor as a genetic marker of morbid obesity. Although there was an association between the Arg64 allele and an earlier onset of obesity in individuals subsequently developing morbid obesity, this allele was not associated with the actual BMI gained or response to weight-loss therapy on a hypocaloric diet.

Adult↗
PubMed1997

Does vaginal cuff closure decrease the infectious morbidity associated with abdominal hysterectomy?

BACKGROUND: Infectious morbidity after total abdominal hysterectomy includes fever (31%) and antibiotic administration (45%). Whether vaginal cuff closure reduces postoperative infectious morbidity remains unresolved. STUDY DESIGN: We reviewed the records of 172 consecutive abdominal hysterectomies for nonmalignant disease performed at an inner-city hospital. We identified potential risk factors for infectious morbidity by univariate analysis and determined adjusted odds ratios by multiple logistic regression analysis. RESULTS: The open vaginal cuff technique was associated with an increased risk of wound infection. Use of prophylactic antibiotics was associated with a decreased risk of febrile morbidity and a decreased risk of prolonged hospitalization. Body weight in the heaviest quartile was associated with increased risk of wound infection, increased risk of prolonged hospitalization, and decreased risk of postoperative vaginal cuff granulation tissue. Older age was associated with an increased risk of prolonged hospitalization. CONCLUSIONS: Closure of the vaginal cuff and use of prophylactic antibiotics at total abdominal hysterectomy were associated with decreased infectious morbidity in a high-risk population.

Antibiotic Prophylaxis↗
PubMedDate not supplied

A comparison of birth weight and weight/length ratio for gestation as correlates of perinatal morbidity.

OBJECTIVE: The purpose was to evaluate a low weight to length ratio as a correlate of perinatal morbidity and mortality. STUDY DESIGN: Data from the Collaborative Perinatal Project for infants of 34 weeks' gestation or more were evaluated. Associations between the weight to length ratio of < 10% (low weight to length) and birth weight of < 10% (small for gestational age) by gestational age and gender, perinatal depression, dysmaturity, cerebral palsy, and neonatal mortality were evaluated. RESULTS: A low weight to length ratio and small for gestational age status were associated with most markers of perinatal morbidity and mortality in term and preterm infants. In infants not small for gestational age, a low weight to length ratio was associated with increased morbidity and mortality (relative risk of 1.9 to 4.2) in term infants, and with perinatal depression (relative risk of 2.9) in preterm infants. Logistic regression found low weight to length ratio was a better independent correlate than small for gestational age status for all markers assessed and found low weight to length ratio was significantly associated with all morbidity and mortality markers in infants not small for gestational age. CONCLUSION: Low weight to length ratio, a marker for asymmetric growth restriction, is correlated with perinatal morbidity, even in infants not small for gestational age.

Birth Weight↗
PubMedDate not supplied

Biliary lithiasis in the elderly patient: morbidity and mortality due to biliary surgery.

BACKGROUND/AIMS: Diseases of the biliary tract are the most common conditions requiring intra-abdominal surgery in elderly patients. Complications and adverse outcomes of gallstones are more frequent in older people. The present study was undertaken to analyze factors that contributed to overall morbidity and mortality after open cholecystectomy. Laparoscopic surgery and other new techniques were compared with the open method. METHODOLOGY: We studied retrospectively 76 patients that were 80 years and older. Each patient underwent operation in our unit. 40 patients had fewer than 30 days of clinical history, and 69 patients (90.8%) were emergency admissions. From a clinical point of view, 33 patients (43.4%) had jaundice on arrival and 21 (27.6%) fever. The operative findings included gallbladder wall infection in 46 patients (60.5%) and common bile duct stones in 25. Uni- and multivariate analysis was performed to discriminate variables in mortality and morbidity. RESULTS: Nine patients (11.8%) died, and 38 had complications in the postoperative period. The main causes of death were pulmonary complications (4) and multisystem organ failure (3). Morbidity was mainly due to wound infection (14), urinary infection (13) and respiratory disease (10). Three variables influenced morbidity: sex (male), cardiovascular disease and jaundice upon admission. In the regression model only cardiovascular disease and jaundice were of independent influence. The mortality rate was associated with pre-operative jaundice. CONCLUSIONS: Mortality and morbidity are related mainly to preoperative presentation. Jaundice is the main determinant of the outcome.

Aged↗
PubMed1998

Topographic documentation of acute radiation morbidity.

BACKGROUND: The clinical knowledge on the frequency and severity of acute radiation morbidity is very sparse. With established morbidity recording, only severe side effects are revealed. The lower morbidity (I/II degree) as a major part of the data base is neglected. Another problem may be the lack of interdisciplinary and international compatibility in other systems. For these reasons, our intention was to create an easily acceptable, international and interdisciplinary compatible documentation form for routine use in radiotherapy. METHODS: A detailed topographic documentation sheet for each major topographic site of clinical radiation oncology has been developed (CNS, head and neck, thorax, female breast, abdomen, extremities). It is based upon existing toxicity codes and documentation systems (CTC[WHO], RTOG and EORTC, DEGRO, ADT, KIEL). Furthermore, basic oncological data like TNM, previous surgery or chemotherapy, drugs and more are included. For each topographic body site, one DIN A4 format is required for documentation of a 6 to 7-week treatment course. The toxicity prescription is coded according to the "DEGRO/RTOG Coding System for acute side effects" and to the "EORTC Acute Toxicity Code" to achieve optimal international and interdisciplinary compatibility. RESULTS: Complete documentation of toxicities level 0 to 4 is to be performed within 2 to 5 minutes per week/patient within preformed marks. The clinical performance has proven excellent. Not only level III/IV toxicities are recorded, but also level I/II morbidity. CONCLUSIONS: The topographic documentation system improves recording of acute morbidity in radiation oncology not only by time, but also in quality. Experimental, radiobiological and former clinical data may be proved for their actual plausibility.

Acute Disease↗
PubMedDate not supplied

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity.

OBJECTIVE: Surgery has been recognized as an effective long-term treatment for morbid obesity. The purpose of this study is to present our experience of laparoscopic adjustable gastric banding (LAGB) as a safe and effective treatment for morbid obesity. METHODS AND PROCEDURES: Over eight months, 39 morbidly obese patients, having a Body Mass Index (BMI) > 40 kg/m2, were included in this study. Conservative measures failed to maintain weight loss in all patients. The procedure is performed through a 5-trocar technique. The procedure involves gastric partitioning and stoma formation by an inflatable band. The stoma can be adjusted by injection of saline in the band reservoir. RESULTS: The mean age of the patients was 31.3 years. The mean BMI was 44.2 Kg/m2. All procedures were completed laparoscopically. The mean hospital stay was 2.7 days. The morbidity rate was 15.32%. Patients were followed up for a mean period of 6.7 months. The mean BMI after six months (in 28 patients) was 36.6 Kg/m2. CONCLUSION: Laparoscopic insertion of the adjustable gastric banding is a safe and effective method for the treatment of morbid obesity and should be the standard way of band insertion.

Adolescent↗