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At least 19 recordsLinked to original sources
PubMed2005

Comparison of bariatric and non-bariatric elective operations in morbidly obese patients on the basis of wound infection.

BACKGROUND: Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. METHODS: A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. RESULTS: Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. CONCLUSION: Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

Adult↗
PubMedDate not supplied

The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗
PubMed2001

The Elite II Bariatric Surgery Retractor system: a recent addition to the bariatric surgeon's tool chest.

BACKGROUND: A good surgical retractor is essential for facilitating bariatric surgery. Recently, Thompson Surgical Instruments designed a new system specifically for bariatric surgical procedures. METHODS: The Elite II Bariatric Retractor system was evaluated in 50 successive bariatric surgical patients. We had the opportunity to modify and improve several major components. We report our experience with this modified retractor system. RESULTS: This system proved to be safe, easy to use, durable, and useful in patients of all BMIs, following modifications and improvements to standard parts. CONCLUSION: This new bariatric retractor system is an improvement over prior bariatric retractor systems being used.

Biliopancreatic Diversion↗
PubMed2006

National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes.

BACKGROUND: The increase in obesity coupled with greater acceptance of the field of bariatric surgery has resulted 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 prospectively 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.

Bariatric Surgery↗
PubMed2005

Attitudes of bariatric surgeons concerning adolescent bariatric surgery (ABS).

BACKGROUND: As the number of adolescents with clinically severe obesity has grown, so too have the number of adolescents seeking bariatric surgery. METHODS: The membership of the ASBS was contacted by e-mail with a 14-question survey to ascertain plans for development of adolescent bariatric surgery (ABS) programs. Results were tabulated and expressed as a percentage of total respondents. RESULTS: Of the 92 respondents, most (84%) performed >50 adult bariatric procedures per year. Over half (53%) had performed ABS. Nearly half (45%) had performed <10 ABS cases within the last year, and 70% were planning ABS in the upcoming year. 42% reported that they have already or were in the process of developing an adolescent bariatric treatment program with pediatric specialists in their community. The vast majority (84%) of respondents was willing to participate in a multi-center collection of outcomes data, and 65% reported having dedicated personnel for clinical data collection. CONCLUSIONS: There is increasing interest in developing ABS programs. Despite the perceived need for such services, information is lacking in the adolescent age group to guide decisions regarding optimal patient selection, choice of operation, and postoperative management. Rigorous evaluation of the outcomes of this intervention with detailed prospective data collection is needed to support decision-making regarding use of bariatric surgery for adolescents with morbid obesity.

Adolescent↗
PubMed2006

Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida.

BACKGROUND: Morbid obesity is an epidemic in America. This series evaluates the safety and efficacy in the first 1,001 laparoscopic bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida. METHODS: A retrospective review was conducted examining all patients undergoing a primary bariatric procedure (either laparoscopic gastric bypass or laparoscopic gastric banding) from July 2000 to December 2003. RESULTS: 2 surgeons performed 1,001 laparoscopic bariatric operations. Average age was 47 (19-75) years, average BMI was 55.6 (35-97) kg/m2, and average ASA class was III. Excess weight loss was 51% at 6 months, 73.4% at 1 year for the gastric bypass group and 54% at 1 year for the laparoscopic banding group. The overall complication rate was 31.8% (12.4% major and 19.4% minor) in the gastric bypass group and 13% in the laparoscopic banding group. There was no postoperative mortality. CONCLUSION: Laparoscopic bariatric surgery is feasible and safe for weight loss. Results obtained have been comparable to those reported for the open approach for weight loss, with a similar major morbidity rate and an improved mortality rate.

Adult↗
PubMed2003

Bariatric surgery and bariatric psychology: general overview and the Dutch approach.

BACKGROUND: Obesity is a chronic, multifactorially caused disease with serious somatic and psychosocial comorbidity as well as economical consequences. In the Netherlands, between 1993 and 1997, the prevalence of morbid obesity was 0.2% for men and 0.6% for women. Although bariatric surgery generally is an effective intervention, it does not lead to equal results in every patient. The long-term efficacy is predominantly determined by compliance to adequate dietary rules in which psychosocial factors can play a major role. METHODS: Questionnaires were sent to the surgery departments of all hospitals in the Netherlands. Subsequently, a second questionnaire was sent to clinical psychology departments of hospitals which perform bariatric surgery. RESULTS: In 28 Dutch hospitals (19%), bariatric surgery is being performed, mostly using restrictive procedures. Almost all hospitals have a multidisciplinary selection-process, and all surgeons and psychologists use multiple selection-criteria. Regarding these criteria, there is more consensus between surgeons than between psychologists. In most hospitals, patients are psychologically assessed prior to surgery. However, postoperative assessment is relatively rare, as is preoperative and postoperative psychological treatment. CONCLUSION: In the Netherlands, bariatric surgery is still relatively uncommon and mostly limited to restrictive procedures. Irrespective of BMI and eating behavior, the majority of patients will be offered a restrictive procedure. The involvement by the psychological and/or psychiatric discipline is not optimal yet; especially, postoperative assessment and pre- and postoperative treatment are not frequently performed, in spite of the fact that these programs can enhance the success rate of bariatric surgery.

Adolescent↗
PubMedDate not supplied

Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study.

BACKGROUND: Obese patients undergoing bariatric surgery are at significant risk for venous thromboembolism (VTE). We performed a multicenter, retrospective survey to evaluate the safety and efficacy of enoxaparin for thromboprophylaxis in patients with morbid obesity undergoing primary bariatric surgery. METHODS: From January to December 2002, 668 patients who underwent primary bariatric surgery at 5 centers were analyzed retrospectively. Baseline patient demographics, objectively diagnosed cases of VTE, and bleeding events were recorded. Patients received enoxaparin preoperatively (30 mg) or postoperatively (40 mg) every 12 or 24 hours or upon discharge (30 mg every 24 hours for 10 days). RESULTS: Overall, there were 6 (0.9%) pulmonary embolisms (PE) and 1 (0.1%) occurrence of deep vein thrombosis (DVT); all but 1 occurred after the cessation of thromboprophylaxis. The highest incidence of VTE was at Center B, which did not administer perioperative thromboprophylaxis (1 DVT and 2 PEs). There were 6 (0.9%) severe bleeding complications: 3 at center D and 3 at center E. In Center B, 2 deaths were recorded (0.3%): 1 due to sepsis and 1 due to bleeding, with both occurring after thromboprophylaxis was discontinued. CONCLUSION: The administration of enoxaparin, in various dosing regimens, is safe for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery. Fewer events occurred with perioperative prophylaxis initiated in the hospital. Because all thromboembolic events occurred after the cessation of thromboprophylaxis, extended thromboprophylaxis may be of value.

Adult↗
PubMed2006

Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry.

BACKGROUND: The epidemic of morbid obesity has increased bariatric procedures performed. Trend analyses provide important information that may impact individual practices. METHODS: Patient data from 137 surgeons were examined from 1987 to 2004 (41,860 patients) using Cochran-Armitage Trend test and Generalized Linear Model. RESULTS: Over an 18-year period, surgeon preference for combined restrictive-malabsorptive procedures increased from 33% to 94%, while simple gastric restriction decreased correspondingly (P < .0001). Surgeons per worksite doubled and cases per surgeon increased 71%. Laparoscopic procedures increased to 24%. The percentage of males, mean operative age, and initial body mass index (BMI) increased significantly (P < .0001). Postoperative hospital stay decreased from 5.0 to 3.9 days (P < .0001). The most common procedure in 2004 was Roux-en-Y gastric bypass (RYGB) (59%). CONCLUSION: Bariatric surgery patients are now older and heavier, length of stay is shorter, and the laparoscopic approach is more frequent. From 1987 to 2004, the general trend shows a clear preference for combined restrictive-malabsorptive operations.

Adult↗
PubMed2005

Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery.

HYPOTHESIS: An increase in national utilization of bariatric surgery correlates with the dissemination of laparoscopic bariatric surgery. DESIGN: Evaluation of Nationwide Inpatient Sample data from 1998 through 2002. SETTING: National database. PATIENTS: A total of 188,599 patients underwent bariatric surgery for the treatment of morbid obesity. MAIN OUTCOME MEASURES: Annual total number of bariatric operations, the proportion of Roux-en-Y gastric bypass vs gastroplasty, the proportion of laparoscopic cases, postoperative length of stay, crude in-hospital mortality, and the number of institutions that perform bariatric surgery. RESULTS: Between 1998 and 2002, the number of bariatric operations increased from 12,775 cases to 70,256 cases. The rate of bariatric surgery increased from 6.3 to 32.7 procedures per 100,000 adults. Laparoscopic bariatric surgery increased from 2.1% to 17.9%. The number of bariatric surgeons with membership in the American Society for Bariatric Surgery increased from 258 to 631, and the number of institutions that perform bariatric surgery increased from 131 to 323. During this 5-year period, the annual rate of laparoscopic bariatric surgery increased exponentially (by 44-fold) compared with a linear growth in open bariatric surgery (by 3-fold). CONCLUSIONS: Between 1998 and 2002, there was a 450% increase in the number of bariatric operations performed in the United States, a 144% increase in the number of American Society for Bariatric Surgery bariatric surgeons, and a 146% increase in the number of bariatric centers. The growth of laparoscopic bariatric surgery during this 5-year period greatly exceeds that of open bariatric surgery.

Adult↗
PubMed2004

The practice of bariatric surgery at academic medical centers.

The growing demand for laparoscopic bariatric surgery has led to an increase in the development of new bariatric surgical practices. Proper hospital facilities and an experienced bariatric surgical team are necessary to ensure optimal patient results. We surveyed academic centers participating in the University HealthSystem Consortium to examine the current practice of bariatric surgery. The survey questioned (1) availability of resources and equipment designed for the morbidly obese, (2) accidents, equipment problems, and workers' compensation relating to the care of bariatric surgical patients, (3) credentialing of bariatric surgeons, and (4) suggestions for improvements in the bariatric surgery program. Twenty-five institutions that perform bariatric surgery responded. Although the majority of institutions noted that they had basic bariatric equipment, some organizations did not have facility resources such as high-weight operating room tables and computed tomography scanners or transfer devices. Twenty-eight percent of institutions reported having accidents or equipment problems and 40% of institutions had workers' compensation claims relating to the care of bariatric patients. With regard to credentialing, 60% of institutions required the surgeons to have performed a minimum number of procedures prior to granting privileges. Suggested improvements included the need for more specialized bariatric equipment, enhancement of the education of all members of the bariatric surgical team, and designation of a bariatric physician who would coordinate care. This survey of bariatric surgery practices at academic medical centers demonstrates that the practice of bariatric surgery could be improved with regard to availability of bariatric equipment and resources and credentialing of surgeons.

Academic Medical Centers↗
PubMedDate not supplied

Bariatric surgery: Asia-Pacific perspective.

BACKGROUND: There is a world-wide epidemic of overweight, obesity and morbid obesity. Bariatric surgery today, as the only effective therapy for morbid obesity, is expanding exponentially to meet the global epidemic of morbid obesity. Bariatric surgeons in the Asia-Pacific region had founded the Asia-Pacific Bariatric Surgery Group (APBSG) at Seoul, Korea on October 6, 2004. METHODS: E-mail requests for information were sent to the national bariatric surgery leaders. These requests were followed, if necessary, by second e-mail requests and communications seeking clarification. The summary data was also discussed at the 1st Asia-Pacific Bariatric Consensus Meeting held in Taipei, February 27, 2005. RESULTS: 11 countries or areas in Asia had started bariatric surgery and responded to the general questions. In 2004, 636 bariatric operations were performed by 61 bariatric surgeons. The earliest data for starting bariatric surgery was in 1974 in Taiwan. Following the development of gastric partition, Taiwan performed the first case in 1981, Japan in 1982 and Singapore in 1987. In 2004, 11 countries have started bariatric surgery. The APBSG was founded in 2004. In 2004, 12.1% of operations were open and 87.9% laparoscopic. The 6 most popular operations were: laparoscopic adjustable banding 42.3%; laparoscopic gastric bypass 34.2%; open vertical banded gastroplasty 7.5%; laparoscopic vertical banded gastroplasty 6.3%; laparoscopic sleeve gastrectomy 6.3%; open gastric bypass 4.2%. Pooling open and laparoscopic procedures, relative percentages were gastric banding 42.3%; gastric bypass 38.4%; vertical banded gastroplasty 13.8%. The APBSG consensus meeting recommended bariatric surgery in Asian patients with BMI >37 or >32 with diabetes or two other obesity-related co-morbidities. CONCLUSIONS: Bariatric surgery is expanding rapidly in Asia to meet rapidly increasing obesity. The modification of the indications for bariatric surgery in the Asian is proposed.

Asia, Southeastern↗
PubMed2006

Who are today's bariatric surgeons and which ones join the ASBS?

BACKGROUND: This study was undertaken to describe bariatric surgeons in the United States today and to determine whether those who are members of a major bariatric surgery specialty society differ from nonmembers. METHODS: We performed a national survey of a 50% cross-sectional random sample of all general surgeons in the United States to determine how many performed bariatric procedures. Through record linkage, we identified which surgeons were members of the American Society of Bariatric Surgeons (ASBS). We used bivariate tests of association (Pearson's chi2, Fisher's exact test, and the Student t-test) to compare demographic, training, and surgical practice characteristics of ASBS members and nonmembers. RESULTS: Of the 2906 survey respondents, 359 (12%) were bariatric surgeons. We estimated response rates of 55% among bariatric surgeons and 27% among others; 46% (n = 163) of those performing bariatric procedures were ASBS members. Members were more likely to be board-certified in general surgery, to perform newer surgical techniques, and to have a higher procedural volume. The years of bariatric experience were similar in the two groups. CONCLUSIONS: Continuing medical education opportunities afforded by specialty society membership allow surgeons to remain abreast of the most recent advances in bariatric surgery technique and effectively address the complex health and psychosocial issues associated with morbid obesity. However, we found that only about half of all surgeons performing bariatric procedures in the United States are ASBS members. Standardization in the form of mandatory involvement in education and training activities or even specialty board certification in bariatric surgery might be necessary to ensure bariatric surgery skills and qualifications across the United States.

Bariatric Surgery↗
PubMed2006

Outcomes of bariatric surgery in the elderly.

The Medicare Coverage Advisory Committee recently concluded that evidence supports the safety and effectiveness of bariatric surgery in the general adult population. However, more information is needed on the role of bariatric surgery in the elderly. The aim of this study was to examine the outcome of bariatric surgery in the elderly performed at academic centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all elderly (>60 years) and nonelderly (19-60 years) patients who underwent bariatric surgery for the treatment of morbid obesity between 1999 and 2005. Outcome measures, including patient characteristics, length of stay, 30-day readmission, morbidity, and observed and expected (risk-adjusted) mortality, were compared between groups. Bariatric surgery in the elderly represents 2.7 per cent (n = 1,339) of all bariatric operations being performed at academic centers. Of the 99 University HealthSystem Consortium centers performing bariatric surgery, 78 centers (79%) perform bariatric surgery in the elderly. Compared with nonelderly patients, elderly patients who underwent bariatric surgery had more comorbidities, longer lengths of stay (4.9 days vs 3.8 days, P < 0.01), more overall complications (18.9% vs 10.9%, P < 0.01), pulmonary complications (4.3% vs 2.3%, P < 0.01), hemorrhagic complications (2.5% vs 1.5%, P < 0.01), and wound complications (1.7% vs 1.0%). The in-hospital mortality rate was also higher in the elderly group (0.7% vs 0.3%, P = 0.03). When risk adjusted, the observed-to-expected mortality ratio for the elderly group was 0.9. In a subset of elderly patients with a pre-existing cardiac condition (n = 236), the in-hospital mortality was 4.7 per cent. Bariatric surgery in the elderly represents only a small fraction of the number of bariatric operations performed at academic centers. Although the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality.

Adult↗